<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405375
Report Date: 09/25/2019
Date Signed: 09/25/2019 01:56:05 PM

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:MCCULLOUGH, KIMFACILITY NUMBER:
073405375
ADMINISTRATOR:MCCULLOUGH, KIMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 374-9893
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY:14CENSUS: 3DATE:
09/25/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kim McCulloughTIME COMPLETED:
02:10 PM
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
An unannounced Case Management site inspection visit was made by LPA Susan Neeson. Met with Kim McCullough. The visit began at 11:00. There are 3 preschool children present. These three preschool children were brought to the facility by their parents, according to Kim McCullough.

The purpose of the visit is to determine if deficiencies cited during last visit have been corrected, There was a citation for car seats not being secure and driving the bus without the proper Class B license. None of the cars used to transport children are available for inspection today.

During the visit the home was inspected. One room has been set up as a bedroom with a bed and bureau She bought two fold-out beds for older children who spend the night. She stated she will purchase one additional fold out bed and two youth beds for the family whose children are here until 11 or 12. She has a rocking chair in the living room in which she will sit when children are napping. She has sheets and pillows for the beds. She will send photos of extra beds.

She stated that neither she nor her helper have obtained a Class B license for driving the bus yet but that she is studying for the test and will send copies of the licenses when she gets them. She stated that she is currently not using the bus to transport children.

Today for pick up at Mira Vista, Wilson elementary in El Cerrito. She also picks up at Murphy's in Pinole. Pickups are between 2 PM and 2:45. Each helper drives their own car and Kim drives her own car. She stated that Doris' car can take 4, her car can take 3 and Sabina can take 3.

Deficiencies are cited on LIC 809 D.

Appeal Rights were discussed. An exit interview was given.




SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: MCCULLOUGH, KIM
FACILITY NUMBER: 073405375
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/26/2019
Section Cited

1
2
3
4
5
6
7
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but
8
9
10
11
12
13
14
are not limited to, the following:(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
This was not met in that car seats used in cars to transport children were not available to be inspected. Cars and car seats were not present during visit.
8
9
10
11
12
13
14
Type B
10/02/2019
Section Cited

1
2
3
4
5
6
7
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, bu
8
9
10
11
12
13
14
are not limited to, the following:(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
This was not met in that beds for all children sleeping at night were not available. 5 children normally stay until between 11 and 1 several nights per week.
8
9
10
11
12
13
14
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: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2