073406205-5-20-2019-02-CC-BDVL-BCCRJT-20190520130430

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073406205
Report Date: 05/20/2019
Date Signed: 05/20/2019 01:04:33 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:	ALVARADO, MELISSA		FACILITY NUMBER:	073406205
ADMINISTRATOR:	ALVARADO, MELISSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 240-8189
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	14	CENSUS: 8	DATE:	05/20/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Melissa Alvarado		TIME COMPLETED:	01:20 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 Belinda Devall arrived at 11:15 A.M. and met with licensee Melissa Alvarado for an UNANNOUNCED RANDOM INSPECTION. Present for this inspection was two fingerprint cleared assistants, one infant, six preschoolers and one school age child. The home was toured to conduct a Health and Safety Inspection. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS include on the upper level of the home the living room, dining room, kitchen, master bedroom with attached bathroom, half bathroom and on the lower level of the home three bedrooms, bathroom, family room, converted garage, downstairs kitchen and backyard. The OFF LIMIT AREAS are the shed and dog area outside which will be inaccessible by closed and/or locked doors, safety gates and visual supervision. Previously, the garage was OFF LIMITS. An approved fire clearance allows the licensee to use the garage for day care. The outdoor play area is free from defects or dangerous conditions and is fully fenced. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today. The fireplace is screened to prevent access by children. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector and working telephone. Per licensee, there are no firearms in the home. At 12:05 P.M., LPA reviewed the staff and facility files. The licensee CPR and First Aid certificate is current and expires 04/07/2020. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 03/26/2019. A child care facility roster was completed and available for review. Staff had their proof of immunization's and mandated reporter training. CONTINUED ON 809-C.........................

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Belinda DeVall	TELEPHONE: (510) 725-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019

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: ALVARADO, MELISSA	FACILITY NUMBER: 073406205
	VISIT DATE: 05/20/2019

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The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. Incidental Medical Services (IMS) were discussed with the licensee. The licensee is not providing IMS at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.
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 reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Belinda DeVall	TELEPHONE: (510) 725-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019

LIC809 (FAS) - (06/04)

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