073405413-7-14-2021-52-CC-JPLA-C4WNXL-20210714105120

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405413
Report Date: 07/14/2021
Date Signed: 07/14/2021 10:51:32 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	CARLSON, NORMA		FACILITY NUMBER:	073405413
ADMINISTRATOR:	CARLSON, NORMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 803-1384
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94583
CAPACITY:	14	CENSUS: 11	DATE:	07/14/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Norma Carlson		TIME COMPLETED:	11:00 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	On July 14, 2021, at 8:45am, Licensing Program Analyst (LPA) Julia Placencia arrived unannounced for a Required-1 Year Inspection, and met with Licensee Norma Carlson. Also residing in the home are the licensee's husband and daughter. Present for this inspection were 11 children (3 infants, 8 preschoolers), and helpers Maria Martinez and Rocio Flores. All adults have proper fingerprint clearances. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 7:30am to 5:00pm. ON LIMITS: Kitchen, living room, family room, 4 bedrooms (for napping infants), hallway half bathroom, backyard. OFF LIMITS: Full bathroom in hallway, garage. Off limit areas are inaccessible by closed and/or locked doors and visual supervision. Licensee is aware she must contact Licensing, so that an inspection can be completed prior to changing an off limits area to on limits. The home is single story, which is neat and clean, with heating and ventilation for safety and comfort. There are child safety gates at each hallway entrance. The outdoor play area is fenced, and free from defects and dangerous conditions. There were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. Fire extinguisher, carbon monoxide and smoke detector meet State Fire Marshall standards. The fireplace in the family room is blocked by a shelf, and the fireplace in the living room is blocked with a board. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills at least twice a year, and the log indicates a drill was conducted on 6/30/21. All required licensing documents are posted and visible for public review. ***Continued on LIC 809C...

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia Placencia	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: CARLSON, NORMA	FACILITY NUMBER: 073405413
	VISIT DATE: 07/14/2021

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At 10:00am, children's files were reviewed and found to be complete. Licensee maintains infant sleep logs. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. The licensee's Pediatric CPR/First Aid certificate is current and expires 10/20/21. Licensee and helpers are in compliance with the immunization law which pertains to day care providers, and mandated reporter training is current. Safe Sleep regulations were discussed. Licensee was reminded that children are never to be left in a parked vehicle.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

There were no deficiencies cited during today's inspection. This report shall remain on file for 3 years. A Notice of Site visit was provided at time of inspection and must remain posted for 30 days.

Exit interview conducted with Norma Carlson. Copy of report and appeal rights provided.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia Placencia	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC809 (FAS) - (06/04)

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