015700341-4-22-2022-52-CC-RHAR-CDQMBW-20220422092836

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700341
Report Date: 04/22/2022
Date Signed: 04/22/2022 09:28:45 AM

Document Has Been Signed on 04/22/2022 09:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	COLLVER, LISA		FACILITY NUMBER:	015700341
ADMINISTRATOR:	COLLVER, LISA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 552-7187
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	14	CENSUS: 0	DATE:	04/22/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	07:59 AM
MET WITH:	Lisa Collver		TIME COMPLETED:	09:40 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On April 22, 2022 at approximately 8:00am Licensing Program Analyst (LPA) Haderer arrived for an announced change of location inspection. Licensee was originally licensed at this location since August 2002. Licensee was planning to move to a new residence 7 houses down the street to live there and offer child care while her current home was being renovated. On February 10, 2022 a change of location application was generated and her current license/facility number was closed. However, a neighbor at the new location made it undesirable to relocate there. Therefore, the change of location application was withdrawn on March 25, 2022. On March 25, 2022 a new change of location application was generated to move the child care back to its original location. Due to the change, a new fire clearance was required by Fremont to ensure the home was at current acceptable standards. On April 21, 2022 the home inspected by Fremont Fire Department and a fire clearance was issued. The only restriction by the fire department is the garage is off limits to children. Present in the home at arrival today was licensee Lisa Collver, her fingerprint and TB cleared husband, two daughters and no children in care. The home was toured to conduct a health and safety inspection. The home is neat and clean with heating and ventilation for safety and comfort. Hours of operation for day care are Monday through Friday, 8:00am to 6:00pm. The home is a single-story ranch stye house with 3 bedrooms, 2 1/2 bathrooms, kitchen, (plus a nook); a “great room” (former dining room with a fireplace, now a play area), a living room (play area), and attached 2-car garage. There is a large backyard play area divided up into 5 sections with farm animals and play structures. There are 3 pigs, 2 goats, (one goat has grown horns and as a result the pen is off limits to children). The perimeter of the property is surrounded by a fence. Licensee also has 2 cats, who LPA were told have current vaccinations. There are ample age appropriate toys.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: COLLVER, LISA	FACILITY NUMBER: 015700341
	VISIT DATE: 04/22/2022

NARRATIVE

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Toxins, medicines, and hazardous items were inaccessible. Facility has a waiver for a woodburning stove.

ON LIMIT AREAS: Main kitchen area, dining room (great room) and living room (play/activity room), 1/2 bathroom near front door, play areas of the back yard (not where any animal pens are located), including the lower level, and front yards.
OFF LIMITS: The remainder of home containing 3 bedrooms and 2 bathrooms; the back yard animal pen areas. Off limit areas are inaccessible by closed and/or locked doors and visual supervision.

There are ample age appropriate toys in good condition and activities available for children. The outdoor play area and child playhouses were found to be free from defects or dangerous conditions. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection. The home has a fully charged 2A10BC fire extinguisher; appropriate smoke detectors and carbon monoxide detectors (tested and working). There is a woodburning fireplace in the great room (day care area) with a waiver and a screen to prevent access to children. Liability insurance supplied by ACC and is current through 1/07/2023.

The licensee’s Health and Safety training is completed, and CPR and First Aid certificate is current and expires 01/09/2023. Mandated Reporter is current and expires 08/09/2022. Assistant’s CPR and First Aid certificate is current and expires 7-29-2023. Mandated Reporter is also current and expires 5/31/22. Licensee is in compliance with immunization laws pertaining to family day care homes. Licensee’s daughter and a staff member have proof of TB tests.

Licensee was reminded that CPR/1st Aide and Mandated Reporter training is to be renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. Per licensee, there are no firearms in the home.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: COLLVER, LISA	FACILITY NUMBER: 015700341
	VISIT DATE: 04/22/2022

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The Change of Location was approved and effective today. A new license will be printed and mailed.

A Notice of Site Visit was printed and issued and must be posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Lisa Collver.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC809 (FAS) - (06/04)

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