070208696-5-29-2019-02-CC-THAR-BCMQDJ-20190529120450

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 070208696
Report Date: 05/29/2019
Date Signed: 05/29/2019 12:04:57 PM

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	KNIGHT, BEVERLY		FACILITY NUMBER:	070208696
ADMINISTRATOR:	KNIGHT, BEVERLY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 757-6864
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	12	CENSUS: 1	DATE:	05/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	BEVERLY KNIGHT		TIME COMPLETED:	12:15 PM

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	LPA Tasha Alexander met with licensee Beverly Knight for an unannounced ANNUAL/RANDOM inspection. Present for the inspection were licensee, and 1 preschool age child in care. LPA toured the facility and backyard for a health and safety inspection. The children's files contained emergency information and immunization blue cards. The home is equipped with a 3A10BC fire extinguisher, working smoke detector and working carbon monoxide detector. There is a working telephone in the home. Per licensee there are no fire arms on the premises. There is an empty swimming pool located in the backyard that has 5 ft fence surrounding it. All poisons, cleaning solutions and medications are inaccessible to children. Licensee has current CPR and 1st Aid training which expires 5/2020 respectively. The off limits areas are all bedrooms and garage. Licensee was also informed of the licensing web address (www.ccld.ca.gov) for downloading child care forms and (www.myccl.com) to register to receive child care updates. A review of staff records on 5/29/19 indicates that all facility staff or other individual who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. Effective September 1, 2016 a person may not work or volunteer at a child care center or family child care home unless he or she has been vaccinated against pertussis, measles, and influenza or has an exemption. Licensee has immunization records in file. The newly implemented mandatory mandated reporter training course was discussed. Licensee has a certificate of completion dated 3/19/18. The new safe sleep practices for infants was also discussed today. Licensee is not currently caring for infants.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KNIGHT, BEVERLY	FACILITY NUMBER: 070208696
	VISIT DATE: 05/29/2019

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This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department. 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

As a result of this visit, there are no deficiencies cited today. This report must be available for public review for 3 years. An exit interview was conducted. A notice of site visit was posted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019

LIC809 (FAS) - (06/04)

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