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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070209174
Report Date: 11/29/2023
Date Signed: 11/29/2023 01:16:18 PM

Document Has Been Signed on 11/29/2023 01:16 PM - 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:PRESLEY, KEVINA FRANCESFACILITY NUMBER:
070209174
ADMINISTRATOR:PRESLEY, KEVINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 593-6258
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
11/29/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:TIME COMPLETED:
01:25 PM
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On November 1, 2023 at 9:20am Licensing Program Analyst (LPA) Indira Loza met with Licensee Kevina Frances for the purpose of conducting an unannounced 3-year annual inspection. Present during today's inspection were the Licensee, 4 infants, and 5 preschool-age children. Operating days and times are Monday - Friday 6am-6:00pm.

The home is single family house; with three bedrooms, two bathrooms, living room, kitchen, backyard, a converted garage.

On Limit Areas - the converted garage, living room, bathroom in the hallway, and the backyard.
Off Limit Areas - all three bedrooms, kitchen (which is only used to go to the bathroom), and the 2nd bathroom.
ISOLATION AREA - is on the couch in the living room.

At 9:21am LPA arrived and noticed 9 children in care at the same time. The home has a fully charged 3A40BC fire extinguisher, a working combined smoke/carbon monoxide detector in converted garage, and a working telephone. Licensee does not have Liability Insurance and was reminded to have parents of newly enrolled children to sign the "Affidavit Regarding Liability Insurance for Family Childcare Home" (LIC 282). Per the Licensee there is nobody in the home with firearm. The Licensee has a current CPR/First Aid certificate which expires on 6/16/25. The Licensee had a current Mandated Reporter certificate which expires on 9/17/2025. The home has heating and ventilation for safety and comfort. LPA observed the backyard to be clean and the Licensee has ample age-appropriate toys and learning materials in the home and in the backyard. Toxins, medicines, and hazardous items were inaccessible during today's inspection. The Licensee provides food to the children. LPA provided the Licensee with the Infant Safe Sleep Regulations and a copy of the "Individualized Safe Sleep Plan" (LIC 9227) was provided.
**********************************Report Continues on LIC 809-C*******************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: PRESLEY, KEVINA FRANCES
FACILITY NUMBER: 070209174
VISIT DATE: 11/29/2023
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02. When any IMS is 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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed onFamily Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During the Exit Interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.



LPA provided the Licensee with the Infant Safe Sleep Regulations and a copy of the "Individualized Safe Sleep Plan" (LIC 9227) was provided and reviewed. LPA assisted the Licensee with signing up to receive PINS.
**********************************Report Continues on LIC809-C********************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
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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: PRESLEY, KEVINA FRANCES
FACILITY NUMBER: 070209174
VISIT DATE: 11/29/2023
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There were two Type A deficiencies cited during todays visit. See LIC809-D. The Licensee must provide a copy of this report to all parents of children currently enrolled, and the parents of newly enrolled children in the next 12 months. In addition, form LIC9224 (Acknowledgment of Receipt of Licensing Reports) must be signed by each parent and placed in each child's file.


Exit interview conducted and report was reviewed with Licensee Kevina Presley.
Report and Appeal Rights were provided.
A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/29/2023 01:16 PM - It Cannot Be Edited


Created By: Indira Loza On 11/29/2023 at 12:18 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: PRESLEY, KEVINA FRANCES
FACILITY NUMBER: 070209174

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as Assistant, Nicole Maker, did not have a fingerprint clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/30/2023
Plan of Correction
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The Licensee shall ensure that Nicole Maker obtains a fingerprint clearance before being present in the facility.
Type A
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as there were 4 infants and 5 preschool age children in care with one staff person caring for the children poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/30/2023
Plan of Correction
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The Licensee shall bring the facility into ratio before the close of business on November 30, 2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023


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