073403933-6-20-2023-02-CC-ILOA-CSYU3L-20230620151342

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073403933
Report Date: 06/20/2023
Date Signed: 06/20/2023 03:13:47 PM

Document Has Been Signed on 06/20/2023 03:13 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:	COLE, PAULINE		FACILITY NUMBER:	073403933
ADMINISTRATOR:	COLE, PAULINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 223-2229
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94806
CAPACITY:	14	CENSUS: 2	DATE:	06/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:19 PM
MET WITH:	Pauline Cole		TIME COMPLETED:	03:23 PM

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On June 20, 2023 at 1:19pm Licensing Program Analyst (LPA) Indira Loza arrived and met with the Licensee Pauline Cole for the purpose of conducting an unannounced 1-year annual inspection. Present for today’s inspection were the Licensee, and two preschool age children care. The facility is in ratio today. Hours of operation are Monday - Friday 7:00am to 6:00pm.

The facility is a single-story home with three bedrooms; three bathrooms; living room; dining room; large family room; kitchen; backyard; and side yard.

ON LIMIT AREAS: Bathroom next to the family room; family room; dining room; backyard, and side yard on the left of the house.

OFF LIMIT AREAS: Both bedrooms to the right of the hallway, the bedroom and two bathrooms to the left of the hallway, kitchen, living room, and the yard on the right side of the house. The off-limit areas will be inaccessible by child gates, closed and/or locked doors and adult supervision.

ISOLATION AREA is in the Dining Room.

The home has heating and ventilation for safety and comfort. The home has a fully charged 2A10BC fire extinguisher next to the dining room. There was a working smoke detector, carbon monoxide detector, and a working telephone. Fire drills are conducted at least once every 6 months, the last drill was completed in April 18, 2023. Licensee has ample age-appropriate toys and learning materials inside and outside the home. Toxins, medicines, and hazardous items were inaccessible during today's inspection. The Licensee utilizes her backyard and side yard for outdoor play. LPA reviewed children's and Licensee's files which were found to be complete. The facility roster was reviewed, and a copy obtained. The Licensee had a current Mandated Reporter certificate which expires May 14, 2024, and CPR expires January 30, 2025.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding **********************************Report Continues on LIC 809-C*******************************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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: COLE, PAULINE	FACILITY NUMBER: 073403933
	VISIT DATE: 06/20/2023

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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.

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/inspection-process.

There were no deficiencies issued during today's visit.

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

Exit interview conducted and report was reviewed with the Licensee Pauline Cole.

Report and Appeal Rights were provided.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC809 (FAS) - (06/04)

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