070213664-6-9-2023-02-CC-ILOA-CSN238-20230609170154

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 070213664
Report Date: 06/09/2023
Date Signed: 06/09/2023 05:02:04 PM

Document Has Been Signed on 06/09/2023 05:02 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:	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: 10	DATE:	06/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:57 PM
MET WITH:	Ellastine Barksdale		TIME COMPLETED:	05:08 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	On June 9, 2023 at 11:50am Licensing Program Analyst (LPA) Indira Loza met with Licensee Ellastine Barksdale for an Unannounced Required Annual Inspection. Present during the inspection was the Licensee, the Licensee's fingerprint cleared sons (2), fingerprint cleared daughter, fingerprint cleared grandson, and an non-fingerprinted adult. The home was toured for a health and safety inspection. The facility operates from 6:30am – 6:00pm Monday – Friday. The home is a single story house that consists of three bedrooms and two bathrooms. The inside of the home was observed to be neat and clean with age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas to the children in care. ON LIMITS AREA: the kitchen, dining room, the living room, the Licensee's bedroom (only used to walk through to the master bathroom), two bathrooms, the family room, the small room next to the kitchen, and the backyard OFF LIMITS AREA: The family room next to the dining room, the front yard, the closed off section of the backyard, and the two bedrooms. ISOLATION AREA: In the dining room The backyard has a play structure with padding underneath to absorb any falls. LPA observed sleeping mats for the children to nap on. The home has a fully charged 2A10BC fire extinguisher in the kitchen, a working smoke detector next to the kitchen, and a functioning carbon monoxide detector. The fire drill log is up to date with the last drill being conducted on June 9, 2023. The licensee's CPR and First Aid certificate is current and expires on July 10, 2023. Per Licensee, there are no firearms in the home. LPA reviewed three ***************************Report continues on on LIC 809-C**************************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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: BARKSDALE, ELLASTINE	FACILITY NUMBER: 070213664
	VISIT DATE: 06/09/2023

NARRATIVE

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staff and six children's files. LPA obtained a copy of the facility roster.

The following was observed during the inspection
- An adult without a background check clearance was present with the children
- There were 10 children with one assistant

Incidental Medical Services (IMS) policy was discussed. Licensee is not providing IMS at this time.For IMS information see PIN 22-02. 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

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 web page 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
*************************************Report Continues on LIC 809-D**************************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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: BARKSDALE, ELLASTINE	FACILITY NUMBER: 070213664
	VISIT DATE: 06/09/2023

NARRATIVE

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information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

See 809D for deficiencies that were cited during today's inspections.

Licensee shall post a copy of the report in a location where all parents can easily view it. All parents of currently enrolled and newly enrolled children during the next twelve months must sign an LIC9224 acknowledgement form and place in each child's file.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted with Licensee Ellastine Barksdale.
Report and Appeal Rights were provided.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/09/2023 05:02 PM - It Cannot Be Edited

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: 06/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102370(d)(1)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in one of four adults present did not have a background check clearance which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 06/12/2023
	Plan of Correction
1 2 3 4	The Licensee shall have the the non-fingerprint cleared adult leave the facility no later than June 12, 2023. The LPA will also make a POC visit within 10 days.

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
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as there were 10 children with one assistant which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 06/12/2023
	Plan of Correction
1 2 3 4	The LIcensee shall bring the facility into ratio no later than June 12, 2023. LPA will be making a POC visit with 10 days.

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	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC809 (FAS) - (06/04)

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