073406568-2-24-2020-02-CC-THAR-BM4RAD-20200224115057

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073406568
Report Date: 02/24/2020
Date Signed: 02/24/2020 11:51:53 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	FERGUSON, ANGELA		FACILITY NUMBER:	073406568
ADMINISTRATOR:	FERGUSON, ANGELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 978-2854
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	14	CENSUS: 3	DATE:	02/24/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	ANGELA FERGUSON		TIME COMPLETED:	11:30 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	LPA Tasha Alexander met with licensee Angela Ferguson for an unannounced ANNUAL/RANDOM inspection. Present for the inspection were licensee, her husband and 3 children in care, consisting of 1 infant, and 2 preschoolers, 1 of which is the licensee's own grandson. LPA toured the facility and backyard for a health and safety inspection. The children's files contained emergency information and immunization blue cards. The home is equipped with a fire extinguisher and working smoke detector. There is a working telephone in the home. Per licensee there are no fire arms on the premises. There are no pools, hot tubs, or other bodies of water at the home. All poisons, cleaning solutions and medications are inaccessible to children. Licensee has current CPR and 1st Aid training which expires 2/8/22 respectively. The off limits areas are are entire upstairs, garage and downstairs bedroom. 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. A review of staff records on 2/24/20 indicates that all facility staff or other individual who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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. Licensee has an exemption letter from her physician that excludes her from receiving the pertussis vaccination. Records for measles vaccination and flu decline letter is in file. The newly implemented mandatory mandated reporter training course was discussed today. Licensee has a certificate of completion dated 1/30/19.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2020

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: FERGUSON, ANGELA	FACILITY NUMBER: 073406568
	VISIT DATE: 02/24/2020

NARRATIVE

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The new safe sleep practices for infants was also discussed today. There is 1 infant in care today. There are 4 play pens available for napping. Licensee is reminded that no blankets, pillows or other items allowed in the play pen when a child is napping.

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

As a result of this visit, there are no deficiencies cited today. This report must be available for public review for 3 years. An exit interview was conducted. A notice of site visit was posted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2020

LIC809 (FAS) - (06/04)

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