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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073401487
Report Date: 01/09/2020
Date Signed: 01/09/2020 12:02:50 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:KELLEHER, NANCYFACILITY NUMBER:
073401487
ADMINISTRATOR:KELLEHER, NANCYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 559-9479
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY:14CENSUS: 12DATE:
01/09/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Nancy KelleherTIME COMPLETED:
12:30 PM
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On 01/09/2020, Licensing Program Analyst (LPA), Melissa Guirit, met with licensee Nancy Kelleher for an UNANNOUNCED RANDOM INSPECTION. Present for this inspection were licensee, two fingerprint cleared assistants, and 12 preschoolers. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are from 8:00 AM to 5:00 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 the lower level of the home, front patio, and backyard. The OFF LIMIT AREAS will be the remainder of the home which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be in an area of the lower lever of the home. The outdoor play area is free from defects or dangerous conditions with 100% supervision. Licensee has pet chickens and a bunny. 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, working smoke detector, working carbon monoxide detector, working telephone, and fully stock First Aid Kit. Per licensee, fire department also came for inspection. The licensee CPR and First Aid certificate is current and expires 08/2020. Licensee completed the Mandated Reporter Training which expires on 01/2020. LPA reminded that the Mandated Reporter Training must be renewed every two years. Licensee is in compliance with the new immunization law. The heater vent near the door of the lower level 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 during 10/2019.

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: KELLEHER, NANCY
FACILITY NUMBER: 073401487
VISIT DATE: 01/09/2020
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(12) Children files were reviewed, (2) employee 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.

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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