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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073404452
Report Date: 12/13/2023
Date Signed: 12/13/2023 11:32:40 AM


Document Has Been Signed on 12/13/2023 11:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:HARRIS, THERESAFACILITY NUMBER:
073404452
ADMINISTRATOR:HARRIS, THERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 233-8328
CITY:RICHMONDSTATE: CAZIP CODE:
94805
CAPACITY:14CENSUS: 10DATE:
12/13/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Theresa HarrisTIME COMPLETED:
11:35 AM
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On 12/13/23 at 9:20am, Licensing Program Analyst (LPA) Ashley Akinleye arrived at the home for an unannounced required 3-year annual inspection. LPA met with Theresa Harris and Assistant. There were 4 infants and 6 children in care during the inspection. This family childcare home operates Monday - Friday 8:00am – 6:00pm.

LPA toured the home with Theresa Harris, to conduct a health and safety inspection. The home is a two story home, and consists of 5 bedrooms, 3 bathrooms, living room, kitchen, dining area, and front yard. LPA observed that the home is neat and clean with heating and ventilation for the safety and comfort of children in care. The on-limit areas include kitchen, one bedroom, living room, family room and downstairs bedroom. The off-limit areas include three bedrooms, and two bathrooms. These areas are made inaccessible by closed and/or locked doors, gates, and visual supervision. LPA observed locks on lower cabinets to prevent access by children. The living room is used for isolation of sick children, away from other children in care. The fireplace in the living room is blocked to prevent access by children. The front yard is used for outdoor play and the yard is fully fenced. LPA did not observe any hazards or dangerous conditions in the yard. LPA observed an ample supply of age-appropriate toys, equipment and activities available for children both indoors and outdoors and observed that they are in good condition. LPA did not observe any bodies of water, toxins, medications or hazardous items that would be accessible to children. The licensees stated that there are no firearms on the premises. There is one pet on the premises.

The home is equipped with fully charged 2A10BC fire extinguishers, a working carbon monoxide detector, working smoke detector, working telephone, and first aid kits and supplies. The licensee have proof of current CPR/First aid certificates, which expire on 5/2025. The last documented fire drill was conducted on 6/2023.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley AkinleyeTELEPHONE: (510) 926-9152
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HARRIS, THERESA
FACILITY NUMBER: 073404452
VISIT DATE: 12/13/2023
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LPA observed all of the required forms posted. LPA reviewed children's files, staff files and obtained a copy of the current roster.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Licensee Theresa Harris was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee Theresa Harris and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

LPA reminded the licensees that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes.

LPA provided the main office number for the Oakland Regional Child Care office (510) 622-2602 for the licensees to call and report injuries or unusual incidents and reviewed the form to follow up in writing within 7 days of the injury/unusual incident. The licensees were encouraged to periodically review regulations, guidelines and Provider Information Notices (PINs) on the website www.ccld.ca.gov.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley AkinleyeTELEPHONE: (510) 926-9152
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HARRIS, THERESA
FACILITY NUMBER: 073404452
VISIT DATE: 12/13/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee Theresa Harris was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee Theresa Harris, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During record review LPA observed that one or more staff did not have current mandated reporter certificates. LPA reminded the licensee that the mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

Based upon observation, interview, and record review two deficiencies were cited today. See 809-D to review deficiencies. Licensee was also provided technical advisories for regulations not cited today pertaining to infant safe sleep.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were printed and given to licensee for review.

Exit interview conducted and report was reviewed with the licensee Theresa Harris.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley AkinleyeTELEPHONE: (510) 926-9152
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 12/13/2023 11:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: HARRIS, THERESA
FACILITY NUMBER: 073404452

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(h)
Infant Safe Sleep
Car seats shall only be used for transportation purposes and shall not be used for sleeping.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above one child was observed to be in car seat asleep during inspection which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/13/2023
Plan of Correction
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Licensee removed infant from car seat during inspection.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above one or more staff did not have current mandated reporter training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/01/2024
Plan of Correction
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Licensee states she will enroll and complete the mandated reporter training by POC due date.
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: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley AkinleyeTELEPHONE: (510) 926-9152
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023
LIC809 (FAS) - (06/04)
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