070211076-1-3-2020-02-CC-PPEN-BKGTG2-20200103134225

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 070211076
Report Date: 01/03/2020
Date Signed: 01/03/2020 01:42:32 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:	KEEL, MESHELLE		FACILITY NUMBER:	070211076
ADMINISTRATOR:	KEEL, MESHELLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 232-8458
CITY:	SAN PABLO	STATE: CA	ZIP CODE:	94806
CAPACITY:	12	CENSUS: 2	DATE:	01/03/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Meshelle Keel		TIME COMPLETED:	01:50 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	Licensing Program Analyst (LPA) Paul Petersen conducted a random annual site inspection for this facility at 1245. LPA met with licensee, Meshelle Keel. Also present at the time of this inspection were licensee's mother, Velma Smith, and two preschool age children in care. All adults present are background cleared and associated to this facility. The facility is within ratio and capacity and children are being supervised. All areas of the home on limits to children in care were toured for a health and safety inspection. The on limits areas are the main childcare room, the children's nap room and the children's bathroom. Off limits areas are made inaccessible by closed doors or child safety gating and visual supervision. The home is clean and organized with available heating and ventilation for comfort. There is a working carbon monoxide detector, working fire alarm and fully charged 3A40BC fire extinguisher. Per licensee there are no firearms present or stored on the premises. There are age appropriate furnishings, play items and equipment, including infant sleeping equipment, which appear free of sharp/broken pieces. The Safe Sleep Awareness Campaign PIN packet was provided and reviewed. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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 Continued on Page 2**************************************************************************************

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

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: KEEL, MESHELLE	FACILITY NUMBER: 070211076
	VISIT DATE: 01/03/2020

NARRATIVE

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The back patio area is fully fenced and on limits to children in care. There are no swings or high climbing equipment present. There are no pools, hot tubs or other bodies of water accessible to children in care. There is one pet (dog).

Children's files were reviewed including parents' rights forms, emergency ID forms and immunization records. Licensee and licensee's mother have current CPR/First Aid certification which expires 01/2020. All required postings are present. The facility roster is up to date.

LPA reviewed with licensee the current Facility Personnel Report Summary and verified that all adults requiring background clearances are cleared and associated to this facility.

Licensee is encouraged to visit www.ccld.ca.gov for licensing regulations and forms. To sign up for quarterly updates contact: childcareadvocatesprogram@dss.ca.gov.

There were no deficiencies cited during this inspection. A notice of site visit was posted and is remain posted for 30 days. A copy of this report is to remain in the facility records and available for review for a period of three years from today's date.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

LIC809 (FAS) - (06/04)

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