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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070212179
Report Date: 07/22/2022
Date Signed: 07/22/2022 02:44:55 PM


Document Has Been Signed on 07/22/2022 02:44 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:COTTER, EVELYNFACILITY NUMBER:
070212179
ADMINISTRATOR:COTTER, EVELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 689-7035
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:12CENSUS: 6DATE:
07/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:37 PM
MET WITH:Evelyn CotterTIME COMPLETED:
03:00 PM
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On 7/22/2022 at 12:37pm, Licensing Program Analyst (LPA) Catherine Fernandes met with Licensee Evelyn Cotter for an Unannounced Required Annual Inspection. Present during the inspection were three fingerprint cleared helpers, and two infants, two preschoolers and two school age children in care. Residing in the home is Licensee, her husband, adult niece, adult son, and sister-inlaw, all are fingerprint cleared and associated to the home. Licensee’s home was toured for a health and safety inspection. The facility operates 7:00am – 6:00pm, Monday - Friday. The home is a two-story house that consists of four bedrooms and three bathrooms. The entrance to the day is on the left side of the house. The inside and outside of the home were observed to be neat, clean with age appropriate materials and toys for the children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. During today’s inspection, LPA observed the following precautions, there is a fireplace in the family room that is covered and the off-limit areas have gates to prevent access. Licensee has stated that there are no firearms or pets in the home.ON LIMITS AREA: the family room on the left side of the house, the bathroom at the end of the hall, and an area of the backyard.

OFF LIMITS AREA: The entire upstairs, the garage, the kitchen, the dining room, and the living room, which will be inaccessible by closed and/or locked doors or visual supervision.


ISOLATION AREA: will be the table next to entrance of the day care.
The home has a fully charged 3A40BC fire extinguisher located on the wall in the main area of the day care and a working smoke detector in the dining room, a carbon monoxide detector in the kitchen.

Report continues on 809C
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: COTTER, EVELYN
FACILITY NUMBER: 070212179
VISIT DATE: 07/22/2022
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Licensee has a working telephone and complete First Aid Kit. All required forms are posted and visible for public view in the childcare room. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 6/6/2022. The Licensee's CPR and First Aid certificate is current and expires on 7/20/2023. The Licensee was reminded of the responsibility as a mandated reporter and needs to provide proof of the required training. LPA did not observe any bodies of water in or around the home.

LPA reviewed six the children’s files, all staff files and obtained a current copy of the facility roster.

Licensee was reminded that California Law requires Licensee to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, 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 of today, the home is not providing IMS.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: COTTER, EVELYN
FACILITY NUMBER: 070212179
VISIT DATE: 07/22/2022
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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/process.

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.

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.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

The following needs to be completed by 8/22/22:
-Send copies of all persons that live in the household and care for children: immunization/flu, LIC508 and LIC9108.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report and appeal rights provided.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4