070213664-10-16-2019-02-CC-PPEN-BGZU6U-20191016151854

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 070213664
Report Date: 10/16/2019
Date Signed: 10/16/2019 03:19:03 PM

COMPREHENSIVE INSPECTION

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:	BARKSDALE, ELLASTINE		FACILITY NUMBER:	070213664
ADMINISTRATOR:	BARKSDALE, ELLASTINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 640-0032
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94806
CAPACITY:	14	CENSUS: 17	DATE:	10/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Albert Barksdale		TIME COMPLETED:	03:25 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 an unannounced random annual site inspection for this facility at 1:40. At the time of LPA's arrival, LPA was met by licensee's husband, Albert Barksdale. Also present at the residence was licensee's adult son, Askia Antar, and 13 children in care consisting of seven preschool age, two infants, and four school age children. Four additional school age children arrived while LPA was still present at the facility for a total of 17 children in care. The facility is over capacity. Licensee's 11 year old grandson who is temporarily residing with licensee was also present. The on limits areas for children in care are the main day care room, the living room, the dining room and the hall bathroom. All on limits areas were inspected for a health and safety inspection. Hazardous items/toxins are stored inaccessible to children in care. Furnishings, equipment, including infant sleeping equipment, and play items are age appropriate and free of observed sharp/broken pieces. There is heating and ventilation available for temperature management/safety. Per licensee's husband there are no firearms stored or present on the premises. Per licensee, the most recent fire department inspection was within the past year. There is a working smoke detector, working carbon monoxide detector and fully charged fire extinguisher. The side patio/outdoor play area is fully fenced and available to children in care. There are no swings or high climbing equipment present. There are no pools, hot tubs or accessible bodies of water. All required postings are present including parents' rights, facility license and emergency disaster plan. 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: 10/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019

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

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: BARKSDALE, ELLASTINE	FACILITY NUMBER: 070213664
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/16/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/17/2019 Section Cited	1 2 3 4 5 6 7	102416.5(d)(2) A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met: (a) At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age. This Facility
	8 9 10 11 12 13 14	was not in compliance with this requirement as evidenced by the presence of 17 children in care at the time of this inspection posing a risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3

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: BARKSDALE, ELLASTINE	FACILITY NUMBER: 070213664
	VISIT DATE: 10/16/2019

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
26
27
28
29
30
31
32

PAGE 2****************************************************************************************************

LPA reviewed the facility, staff and children's records including parents' rights forms and emergency ID forms. Licensee and Licensee's husband have current CPR/First Aid certification which expires 06/2020.

The Safe Sleep Awareness Campaign informational was provided and discussed. 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.

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

California Code of Regulations, Tittle 22, is being cited on the attached LIC 9099D for a Type A violation. This citation must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled in the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child’s file to be reviewed by licensing.

An exit interview was conducted and a copy of the appeal rights provided. A notice of site visit was printed and is to remain posted for thirty days. A copy of this report is to be available in the facility records for a period of three years.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3