073401037-1-3-2020-02-CC-PPEN-BKGRLR-20200103120733

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073401037
Report Date: 01/03/2020
Date Signed: 01/03/2020 12:07:41 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:	WALKER, LORI		FACILITY NUMBER:	073401037
ADMINISTRATOR:	WALKER, LORI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 222-4029
CITY:	EL SOBRANTE	STATE: CA	ZIP CODE:	94803
CAPACITY:	14	CENSUS: 5	DATE:	01/03/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Lori Walker		TIME COMPLETED:	12:15 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 1100. At arrival LPA met with licensee, Lori Walker. Also present at the time of LPA's arrival were six children in care including licensee's six year old grandson, one infant and four preschool age children along with licensee's daughter, Jessica Walker, and assistant, Nina Buenvenida. All adults present are background cleared and associated to this facility. The facility is within ratio and capacity. The On Limits areas for children in care are the fully converted garage, and the children's bathroom in the main house. Off limits are made inaccessible by closed doors or child safety gating and visual supervision. There are age appropriate furnishings and equipment, including infant sleeping equipment, that appear free of hazardous conditions. There were no hazardous items/toxins observed to be accessible to children in care. 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. A portion of the patio which is adjacent to the child care room is on limits to children in care. The children's patio area is separate from the remainder of the outdoors/patio by child safety gating. There is a trampoline which is in the the off limits areas of the outdoors and not used by children in care. The hillside area is off limits to children in care. There are no swings or pieces of high climbing equipment present in the on limits of the outdoor area. There are no pools, hot tubs or other bodies of water accessible to children in care. 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: WALKER, LORI	FACILITY NUMBER: 073401037
	VISIT DATE: 01/03/2020

NARRATIVE

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Children's files were reviewed including consents for emergency medical treatment, parent's rights forms, emergency information forms and immunization records. Facility and personnel records were reviewed. Licensee and assistant have current CPR/First Aid which expires 04/2021. The facility roster is up to date. The disaster drill log is current.

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

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.

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 posted and is to remain posted for 30 days from today's date. This report is to remain in the facility records and available for public review 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: 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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