073404113-7-25-2019-02-CC-CACA-BEEPNV-20190725112834

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073404113
Report Date: 07/25/2019
Date Signed: 07/25/2019 11:28:38 AM

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:	WHITE, ELISABETH		FACILITY NUMBER:	073404113
ADMINISTRATOR:	WHITE, ELISABETH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 634-5510
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	14	CENSUS: 12	DATE:	07/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Elisabeth White		TIME COMPLETED:	11:45 AM

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) Cherie Acosta conducted an unannounced ANNUAL/RANDOM inspection. Present during today’s inspection was the licensee, her fingerprint cleared son/assistant, two infants, nine preschool aged children, and one school aged child in care. The home was toured for Health and Safety Inspection. On limits area consist of the kitchen, living room, two bedrooms, hallway bathroom and backyard. During the inspection the licensee requested to have the master bedroom made on limits. LPA inspected the master bedroom, it was observed to be safe for children. All three bedrooms in the home are now on limits. Off limits area consist of the laundry room, garage, and master bathroom. The home was observed to be orderly, with heating and ventilation for safety and comfort. There are no pools, spas, hot tubs, or any other similar bodies of water at this home. There are no firearms on the premises as stated by the licensee. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored and inaccessible to children. The fireplace is barricaded to prevent access by children. LPA verified that the fire extinguisher is fully charged. The home is equipped with both a smoke detector and carbon monoxide detector. There is a working telephone in the home. The home provides appropriate toys, learning materials and play equipment. Outdoor play area is fenced. The licensee was reminded that children are not to be left in parked vehicles. The licensee is operating within the licensed capacity. LPA did not observe any child left without supervision during the inspection. Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children or an immediate civil penalty can be assessed.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019

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: WHITE, ELISABETH	FACILITY NUMBER: 073404113
	VISIT DATE: 07/25/2019

NARRATIVE

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Children files were reviewed. Files reviewed contain children’s emergency information. The licensee has current CPR and First Aid which expires 4/3/20. Licensee completed mandated reporter training 3/6/18. Licensee has proof of required immunizations.

Fire and disaster drills are conducted at least once every six months.

Incidental Medical Services (IMS) was discussed. The following information regarding ADA was provided to licensee. US DOJ toll free ADA Information Line (800)514-0301 FAQ and ADA http://www.ada.gov/childqanda.htm LPA discussed the requirement to create a plan of operation when needed. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417.

Licensee was encouraged to email ChildCareAdvocatesProgram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

Information on safe sleep was provided and discussed with the licensee.

There are no deficiencies cited during today’s inspection.
Exit interview was conducted with Elisabeth White.
Licensee was provided a copy of the appeal rights.
Notice of Site visit was provided at the time of inspection and must be posted for 30 days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019

LIC809 (FAS) - (06/04)

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