070215056-3-12-2020-02-CC-MGUT-BMMRTC-20200312131806

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 070215056
Report Date: 03/12/2020
Date Signed: 03/12/2020 01:18:11 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:	LYNCH, CARMELITA		FACILITY NUMBER:	070215056
ADMINISTRATOR:	LYNCH, CARMELITA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 245-8100
CITY:	HERCULES	STATE: CA	ZIP CODE:	94547
CAPACITY:	12	CENSUS: 6	DATE:	03/12/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Carmelita Lynch		TIME COMPLETED:	01:40 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 03/12/2020 at 12:30 PM, Licensing Program Analyst (LPA), Melissa Guirit, met with licensee Carmelita Lynch for an UNANNOUNCED ANNUAL RANDOM INSPECTION. Present for this inspection were licensee, fingerprint cleared husband, 1 infant, and 5 preschoolers. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are from 7:00 AM to 6:15 PM. The home is two story. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREA is the entire downstairs area and the backyard. The OFF LIMIT AREAS are the laundry room, entire upstairs, and garage which will be inaccessible by closed and/or locked doors, safety gates, and visual supervision. The ISOLATION AREA will be in the living room near the entry way. The outdoor play area is free from defects or dangerous conditions and is completely fenced with 100% supervision. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today. The home has a fully charged 3A40BC fire extinguisher, pull down fire alarm, working smoke detector, working carbon monoxide detector, working telephone, and fully stock First Aid Kit. The licensee and husband's CPR and First Aid certificate is current and expires 06/2021. Licensee and husband completed the Mandated Reporter Training which expires on 01/16/2022. Licensee is in compliance with the new immunization law. The fireplace in the family room is screened to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one on 02/27/2020. At 12:55 PM, (5) Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

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: LYNCH, CARMELITA	FACILITY NUMBER: 070215056
	VISIT DATE: 03/12/2020

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Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov .http://www.myccl.gov/

Individual Medical Services (IMS) policy was discussed. 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

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted with licensee, Carmelita, and appeal rights provided.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

LIC809 (FAS) - (06/04)

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