073406092-11-12-2021-02-CC-THAR-C8PU3D-20211112141323

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073406092
Report Date: 11/12/2021
Date Signed: 11/12/2021 02:13:46 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:	PRINGLE, NINA		FACILITY NUMBER:	073406092
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	11/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	NINA PRINGLE		TIME COMPLETED:	02:15 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	LICENSING PROGRAM ANALYST TASHA ALEXANDER MET TODAY WITH LICENSEE NINA PRINGLE FOR AN UNANNOUNCED INCREASE OF CAPACITY AND 1 YEAR ANNUAL/REQUIRED INSPECTION. PRESENT FOR THE INSPECTION IS LICENSEE, HER HUSBAND AND 6 CHILDREN IN CARE CONSISTING OF 2 PRESCHOOLERS AND 4 SCHOOL AGE. LPA TOURED THE FACILITY AND BACKYARD FOR A HEALTH AND SAFETY INSPECTION. THE CHILDREN'S FILES WERE REVIEWED AND CONTAINED EMERGENCY INFORMATION. THE HOME IS EQUIPPED WITH A 2A10BC FIRE EXTINGUISHER, WORKING SMOKE ALARM AND WORKING CARBON MONOXIDE DETECTOR. THERE IS A WORKING TELEPHONE IN THE HOME NO CHANGE. PER LICENSEE THERE ARE NO FIRE ARMS LOCATED ON THE PREMISES. THERE ARE NO SWIMMING POOLS, HOT TUBS OR ANY OTHER BODIES OF WATER LOCATED AT THE HOME. ALL POISONS, TOXINS, CLEANING SOLUTIONS AND MEDICATIONS ARE INACCESSIBLE TO CHILDREN IN CARE. LICENSEE HAS CURRENT CPR AND 1ST AID TRAINING WHICH EXPIRES 7/12/22 RESPECTIVELY. THE OFF LIMITS AREAS ARE THE ENTIRE UPSTAIRS AND THE GARAGE. TODAY THE 5TH BEDROOM LOCATED DOWNSTAIRS WILL NOW BE "ON LIMITS" AND USED FOR CHILD CARE PURPOSES. Licensee was also informed of the licensing web address (www.ccld.ca.gov) for downloading child care forms and (www.myccl.com) to register to receive child care updates. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. A review of staff records on 11/10/21 indicates that all facility staff or other individual who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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 3

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: PRINGLE, NINA	FACILITY NUMBER: 073406092
	VISIT DATE: 11/12/2021

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
26
27
28
29
30
31
32

Effective September 1, 2016, a person may not work or volunteer at a child care center or family child care home unless he or she has been vaccinated against pertussis, measles and influenza or has an exemption.

Today the newly implemented mandatory mandated reporter training course has also been discussed. CERTIFICATE IS UP TO DATE- RENEW THIS MONTHER 11/2021

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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: PRINGLE, NINA	FACILITY NUMBER: 073406092
	VISIT DATE: 11/12/2021

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
26
27
28
29
30
31
32

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/process.

As a result of this visit, there are no deficiencies cited today. This home will be licensed for a large family child care home as of today 11/12/21.

An exit interview was conducted. A notice of site visit was posted.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3