073401640-6-8-2023-02-CC-MPRE-CSM47H-20230608185110

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073401640
Report Date: 06/08/2023
Date Signed: 06/08/2023 06:51:32 PM

Document Has Been Signed on 06/08/2023 06:51 PM - It Cannot Be Edited

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:	ROUNDTREE, STACIE		FACILITY NUMBER:	073401640
ADMINISTRATOR:	ROUNDTREE, STACIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 628-1150
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	14	CENSUS: 13	DATE:	06/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:36 PM
MET WITH:	Stacie Roundtree		TIME COMPLETED:	06:45 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 6/8/2023 at 2:36pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Stacie Roundtree for a Required – 1 Year Inspection. Present during the inspection was the Licensee, her three (3) helpers, J. Jackson, M. Alvarez and B. Hernandez-Salcedo. There were six (6) school age children, and eight (8) preschool age children present as well. The facility operates from 7:30am – 6:00pm, Monday - Friday. Licensee stated she does not care for infants. ON LIMITS AREA: Living Room, Dining Area, Kitchen, Family Room, Downstairs Half Bathroom and Backyard OFF LIMITS AREA: Entire 2^nd Floor and Garage ISOLATION AREA: Living Room Licensee has obtained a city permit for the off-limit garage and will need a fire clearance for Community Care Licensing. Licensee is currently cleared to use the garage while clearance is being obtained. LPA will work with Licensee to obtain clearance. If clearance is denied, childcare operation in the garage must cease. The facility is a two-story home rented by the Licensee. The inside of the home was observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. All off-limit areas will be made inaccessible with locks and gates. Licensee provides all food for the children. All food that is brought from the children’s home will be properly labeled and stored. During LPA’s inspection it was found that the stairs were not gated. LPA informed Licensee that stairs must be gated when children 5 and younger are present. Licensee placed a gate at the bottom of the stairs during the inspection. Licensee stated they do transport children from school. Proof of registration and insurance was obtained. There is one (1) small dog and one (1) firearm in the home.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

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: ROUNDTREE, STACIE	FACILITY NUMBER: 073401640
	VISIT DATE: 06/08/2023

NARRATIVE

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The home has one (1) fully charged 3A40BC fire extinguisher on the wall between the kitchen and the hallway. There is a 2A10BC fire extinguisher in the garage. There is one (1) working smoke/carbon monoxide detector in the dining area and in the garage and the family room. The home is equipped with central heat and air for proper ventilation. The fireplace in the family room is not in use and blocked with furniture making it inaccessible to the children in care.

The backyard is fully fenced, well maintained with ample age-appropriate materials for the children. There are three (3) sheds used for storage in the backyard. Two (2) sheds were not locked and could be a potential danger to the children. Licensee will ensure that the storage containers are locked from now on. There is a play structure that is anchored into the ground for extra safety. Licensee has placed cushion under the slide for extra safety as well. LPA did not observe any bodies of water in or around the home that could be a potential danger to the children in care.

Licensee’s Health and Safety training has been completed. Licensee’s Pediatric CPR and First Aid training is complete and expires 2/23/2025. Licensee’s Mandated Reporter training is complete and expires 1/17/2025. All required forms are posted for visible for public view by the door leading to the backyard. Licensee’s fire drill log is complete with the last drill logged 6/1/2023. LPA obtained the children’s files, facility files, and facility roster. All files were complete.

No deficiencies were cited during the inspection.

Licensee was reminded that California Law requires Licensee to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

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: ROUNDTREE, STACIE	FACILITY NUMBER: 073401640
	VISIT DATE: 06/08/2023

NARRATIVE

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Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.comLPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

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: ROUNDTREE, STACIE	FACILITY NUMBER: 073401640
	VISIT DATE: 06/08/2023

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Stacie Roundtree.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

LIC809 (FAS) - (06/04)

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