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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405365
Report Date: 08/08/2019
Date Signed: 08/08/2019 01:13:43 PM

COMPREHENSIVE INSPECTION
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:COOPER, JESUSA JFACILITY NUMBER:
073405365
ADMINISTRATOR:COOPER, JUSUSA JFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 270-3324
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:14CENSUS: 8DATE:
08/08/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:COOPER, JESUSA, LICENSEETIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Redmond arrived at the facility to conduct an unannounced, Annual/Random inspection visit on 08/08/19 at 12:30 PM. On this date, LPA met with Jesusa Cooper, Licensee.

Capacity: The facility operates as a Family Day Care (large) and is licensed for fourteen (14) children. On this date, there are eight (8) preschool aged children. The Licensee and a volunteer is providing care and supervision to the children. The facility is in compliance with capacity limitation and staff to child ratios.

The Licensee designated areas of the facility to allow and restrict access to. These areas are indicated below:

Areas accessible to children in care "On Limit" include:

· Family room
· Two bedrooms –equipped with appropriate infant sleep areas
· Restroom – toilet and sink, sanitary items, no cleaning solutions or hazards
· Kitchen – dining area
· Backyard (barricaded by fence)

Areas inaccessible to children in care “Off Limit” include:

· Kitchen
· Private bedrooms

CONTINUED
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
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: COOPER, JESUSA J
FACILITY NUMBER: 073405365
VISIT DATE: 08/08/2019
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Emergency Preparedness/Safety: The Licensee and all adults presently in the home have criminal background clearances and are associated with the facility. The Licensee has current pediatric first aid and CPR certification which expires on 05/11/21. Mandated Reporter training was completed on 09/10/2018 and is current. There is an operable carbon monoxide detector. There is an operable smoke detector. The fire extinguisher is fully charged and has a classification of 2 A 10 B:C. Emergency Disaster Plan was last updated on 01/02/19 and is current, per Licensee. First aid supplies available. Facility utilizes a cellular telephone line for telephone service. There are no firearms, per the Licensee. The Licensee is/is not providing *Incidental Medical Services (IMS) services currently. Licensee is currently providing care for infants and is aware of Safe Sleep regulations. LPA consulted with Licensee on the new regulations and information on Safe Sleep Regulations requirements can be found online.

Postings: Facility License, Emergency Disaster Plan, Notification of Parent's Rights, Earthquake Preparedness Checklist. California Passenger Safety. If You See Something, Say Something.

Overall the facility is clean and appears in good repair. The facility is ventilated, and the temperature is comfortable.
NO DEFICIENCIES CITED ON THIS DATE

Exit interview conducted. Facility Evaluation Report issued and discussed with Licensee. A copy of this report shall be available for 3 years and provided to parents/others upon request. Notice of Site Visit issued and discussed with Licensee signature obtained below. Notice of site visit shall be posted remain posted for 30 days. Failure to keep this notice posted for the 30 consecutive days will result in an immediate $100 civil penalty.
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
LIC809 (FAS) - (06/04)
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