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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073400724
Report Date: 01/09/2020
Date Signed: 01/09/2020 01:32:10 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:MCGEE, DINAFACILITY NUMBER:
073400724
ADMINISTRATOR:MCGEE, DINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 724-1268
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY:14CENSUS: 7DATE:
01/09/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Dina McGeeTIME COMPLETED:
02:00 PM
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On 01/09/2020, Licensing Program Analyst (LPA), Melissa Guirit, met with licensee Dina McGee for an UNANNOUNCED RANDOM INSPECTION. Present for this inspection were licensee, fingerprint cleared assistant and mother, Renee, 2 infants, and 5 preschoolers. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are from 7:30 AM to 5:30 PM.

The home is two story. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are now the sun room which is the day care room, bathroom connected to the sun room, back room converted to a play room, and back yard. The OFF LIMIT AREAS are the rest of the home which is inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be in the back play room. The outdoor play area is free from defects or dangerous conditions 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 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and fully stock First Aid Kit. The licensee's CPR and First Aid certificate is current and expires 05/23/2020 . Licensee and assistant completed the Mandated Reporter Training which expires on 03/2020. Licensee is in compliance with the new immunization law. Licensee's home has centralized heating and air, therefore, there are nor wall heaters or fireplaces accessible in the home. 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 11/18/2019.

(7) 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 JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa GuiritTELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
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: MCGEE, DINA
FACILITY NUMBER: 073400724
VISIT DATE: 01/09/2020
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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/

Incidental Medical Services (IMS) policy was discussed.

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 and appeal rights provided.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa GuiritTELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
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