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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403182
Report Date: 06/06/2019
Date Signed: 06/06/2019 04:29:33 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:WIMBERLY, KATHLEENFACILITY NUMBER:
073403182
ADMINISTRATOR:WIMBERLY, KATHLEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 232-6829
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY:14CENSUS: 16DATE:
06/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Kathleen WimberlyTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) conducted an unannounced random annual site inspection for this facility on 06/06/19 at 1435. Upon arrival, LPA was met by assistant, Jamyang Dohma. Also present were assistant Tenzin Nyiden and 16 children in care consisting of four infants and 12 preschool age children and one school age child. The facility is over capacity. Licensee arrived approximately fifteen minutes after LPA arrived at the facility. Licensee assisted LPA with touring the on limits areas for children in care. On limits areas are the upper and lower bedrooms, the bathroom, the living room and adjoining dining area. The off limits areas are the kitchen and the entire bottom floor of the residence. Off limits are made inaccessible by closed doors and/or child safety gating. There is a door at the top of the stairs which is kept closed to make the stairs and lower level of the house inaccessible to children in care. Per licensee there are no firearms stored or present on the premises. Licensee is reminded to ensure adequate indoor temperature management for children's comfort. There were no hazardous items observed to be accessible to children in care. The fully fenced outdoor play area is available to children in care with adult supervision present at all times that children are using the area. The high climbing equipment/swings are securely anchored and free of broken/sharp pieces. Licensee is reminded to frequently inspect and maintain all wooden furniture and play structures to ensure safety and avoid slivers/injury to children. There are no pools, hot tubs or other bodies of water present. The facility has infant sleeping equipment which is free of broken/sharp pieces. LPA provided licensee with a copy of the Child Care Providers Guide to Safe Sleep and discussed the safe sleep regulations. Licensee has current CPR/First Aid which expires 12/3/19. There is a working smoke detector along with centralized fire alarm, fully charged fire extinguisher and carbon monoxide detector. LPA reviewed the Facility Personnel Report Summary with licensee and verified that all adults requiring background clearances are cleared and associated to this facility. 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
The attached Type A deficiency was cited during this inspection. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled in the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child’s file to be reviewed by licensing. A copy of the AB 633 was provided. LPA provided a copy of the appeal rights and a notice of site visit was provided. This notice is to be posted at this facility for a period of 30 days from today's date. A copy of this report is to remain available in the facility file for three years.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
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: WIMBERLY, KATHLEEN
FACILITY NUMBER: 073403182
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/07/2019
Section Cited
CCR
102416.5
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102416.5(f) The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children. This facility was not in compliance with this requirement as evidenced by 16 children in care including four infants and 12 preschool age children present at the time of this inspection posing immediate risk to children.
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Licensee agrees to ensure that the facility will adhere to capacity requirements including not exceeding 14 children present at any one time going forward. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
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