073404452-3-12-2020-02-CC-PPEN-BMMPUZ-20200312113823

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073404452
Report Date: 03/12/2020
Date Signed: 03/12/2020 11:38:30 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:	HARRIS, THERESA		FACILITY NUMBER:	073404452
ADMINISTRATOR:	HARRIS, THERESA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 233-8328
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94805
CAPACITY:	14	CENSUS: 0	DATE:	03/12/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Theresa Harris		TIME COMPLETED:	11:35 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) Paul Petersen conducted an unannounced random annual site inspection for this facility at 0925. LPA met with licensee, Theresa Harris, who was present along with licensee's husband, Craig Harris, licensee's mother, Wanda Klopspon, and there were no children in care. All adults present are background cleared and associated to this facility. All on limits areas were toured for a health and safety inspection. The areas on limits to children in care are the kitchen and dining area, the family room/play room, the nap room and the children's bathroom. The facility has working carbon monoxide detector, working smoke alarms and fully charged 3A40BC fire extinguisher. There is age appropriate furnishings, play items and equipment (including infant sleeping equipment) which are free of observed broken/sharp pieces. The fireplace is screened to prevent access. There is a wall heater which is screened to prevent access. Hazardous items/toxins are made inaccessible by child safety fasteners. Per licensee, there are no firearms stored or present on the premises. The outdoor patio/yard area is fully fenced and on limits to children in care. There are no swings or high climbing equipment present. There are no pools, hot tubs or other bodies of water present. Required postings are present. Children's files were reviewed for parent's rights forms, identification and emergency information forms and immunization records. Continued on Page 2*************************************************************************************

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

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: HARRIS, THERESA	FACILITY NUMBER: 073404452
	VISIT DATE: 03/12/2020

NARRATIVE

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Staff and facility records were reviewed for background clearances, and CPR/First Aid. Licensee's husband has CPR/First Aid which expires 05/2021.

LPA reviewed with licensee the Facility Personnel Report Summary and verified that all adults requiring background clearances are cleared and associated to this facility.

Licensee is encouraged to visit www.ccld.ca.gov for licensing regulations and forms. To sign up for quarterly updates contact: childcareadvocatesprogram@dss.ca.gov. Licensee is reminded that the Mandatory Reporter Training is due to be completed for all child care staff every two years at mandatedreporterca.com. The Safe Sleep Regulations for infants was reviewed and provided to licensee.

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

There were no deficiencies cited during this inspection. A copy of the appeal rights was provided and a notice of site visit was printed and posted and is to remain posted for a period of 30 days. A copy of this report is to be available in the facility records for three years from today's date.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

LIC809 (FAS) - (06/04)

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