070214960-1-3-2020-02-CC-PPEN-BKGPSZ-20200103103511

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 070214960
Report Date: 01/03/2020
Date Signed: 01/03/2020 10:35:17 AM

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:	HARTFIELD, CAROLYN & DAVID		FACILITY NUMBER:	070214960
ADMINISTRATOR:	HARTFIELD, CAROLYN & DAVID		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 223-4832
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94806
CAPACITY:	12	CENSUS: 4	DATE:	01/03/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Carolyn and David Hartfield		TIME COMPLETED:	10:45 AM

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 0915. At arrival LPA met licensees, David Hartfield and Carolyn Hartfield. Also present were four children in care consisting of one infant and three preschool age children. All adults present are background cleared and associated to this facility. The facility is within ratio and capacity and children are being supervised. The On Limits areas for children in care are the fully converted garage, the kitchen/dining room area, the nap room and the children's bathroom. Off limits are made inaccessible by closed doors and visual supervision. Hazardous items/toxins are stored inaccessible to children in care. There are age appropriate furnishings, equipment (including infant sleeping equipment) and play items that appear free of hazardous conditions. The facility has multiple working carbon monoxide detectors, working fire alarm and fully charged 3A40BC fire extinguisher. Per licensee there are no firearms present or stored in the premises. The back patio area is fully fenced and on limits to children in care. The entry gate and gate to the storage area will be closed/latched whenever children are using the patio area. The hillside area is off limits to children in care. There are no swings or pieces of high climbing equipment present. There are no pools, hot tubs or other bodies of water accessible to children in care. All required postings are present. A sampling of children's files was reviewed for completeness including parent's rights forms, emergency information forms and immunization records. Facility records were reviewed including licensee CPR/First Aid. Licensee has current CPR/First Aid which expires 09/2021. The facility roster is up to date. 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: HARTFIELD, CAROLYN & DAVID	FACILITY NUMBER: 070214960
	VISIT DATE: 01/03/2020

NARRATIVE

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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.

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

The Safe Sleep Awareness Campaign PIN packet was provided and reviewed. 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 printed and posted and is to remain posted for 30 days. A copy of this report is to be kept and available for review in the facility records for 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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