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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407132
Report Date: 01/26/2023
Date Signed: 01/26/2023 01:22:36 PM


Document Has Been Signed on 01/26/2023 01:22 PM - It Cannot Be Edited

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:COLLINS, YVETTEFACILITY NUMBER:
073407132
ADMINISTRATOR:COLLINS, YVETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 777-1553
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:14CENSUS: 5DATE:
01/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Yvette CollinsTIME COMPLETED:
01:20 PM
NARRATIVE
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On 01/26/2023 at 9:00 AM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced 5 year required annual inspection for Yvette Collins's large family child care home. LPA met with licensee and guided analyst on a tour of the facility. During today's inspection, there were 5 children in care (2 infants and 3 preschool children) and an volunteer (licensee adult child) Licensee's foster child was also present during inspection. Family members residing in the home are licensee, licensee's spouse, licensee's 3 adult children, licensee 17 year old minor child and licensee's foster child. Facility hours of operations are Monday - Friday from 5:00 AM - 7:00 PM.

This is a two story home which consists of 4 bedrooms, 2 1/2 bathrooms, kitchen, dining room, living room, family room, downstairs bedroom (den), laundry room, attached garage, and the backyard with a pool, and 2 locked sheds.
The children on limits areas: Living room, family room, half bathroom, kitchen, dining room, and the backyard
Areas off limits include: Entire second floor which includes 3 bedrooms, 2 bathrooms, attached garage, laundry room, downstairs bedroom (den), office.
The LPA toured all areas used by children during this visit.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating system for safety and comfort. There were safe toys, play equipment and materials observed for children. There are stairs in the home that are made inaccessible for children in care. There is a working telephone in the home. Detergents, poisons, cleaning compounds, medications, and other items which can pose a danger to children are made inaccessible in the home. LPA observed children in off limit areas. Also, licensee admitted to walking though the garage with children to access backyard. LPA reminded licensee that children cannot have access to off limits areas. Licensee must put in a request to licensing to update on/off limits area and must gain final approval before using updated area. *CON'T ON PAGE 2*
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023
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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Document Has Been Signed on 01/26/2023 01:22 PM - It Cannot Be Edited

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: COLLINS, YVETTE
FACILITY NUMBER: 073407132

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when LPA observed children in off limit area and licensee admitted that children walk thought off limit area which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/15/2023
Plan of Correction
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Licensee will update on limits area for office. Licensee will write a statement to not use garage to get to backyard.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above when licensee did not complete an up to date child's roster which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/15/2023
Plan of Correction
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Licensee will submit child's roster to licensing.
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: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023
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: COLLINS, YVETTE
FACILITY NUMBER: 073407132
VISIT DATE: 01/26/2023
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*PAGE 2*
Per licensee, there are no weapons or firearms in the home. Licensee has an up to code 3A40BC fire extinguisher and working smoke/carbon monoxide detector on the premises. LPA observed a screened fireplace in the family room. Licensee last conducted fire drill June 2022 however licensee stated she did not log fire/earthquake drill. LPA reminded licensee of requirement to log fire/earthquake drills. Licensee stated she has two dogs in the facility.

Licensee stated she does use backyard for outdoor play activities. LPA inspected the backyard. Backyard is safe and fully fenced. LPA observed swimming pool in the back yard and a pool cover that can hold an adult human weight. LPA also observed 2 locked sheds in the backyard. Licensee stated she uses a park nearby for outdoor activity. LPA reminded licensee when outside of facility, 100% supervision of children in care is required. Facility does provide transportation for children, but licensee understands that children cannot be left alone, unattended in parked vehicles

Child record were reviewed to ensure that each child has an Identification and Emergency form. Majority of children's files contained required documents. Licensee admitted she could not find one file for preschool child. LPA reminded licensee of the requirement to have the necessary forms in the child's file. The licensee did complete Pediatric First Aid and CPR certificate however it does not hold the ESMA certification. LPA informed licensee that she has complete CPR/First Aid certificate with ESMA certification. Required postings were observed near the entrance. Licensee stated she currently does not have an up to date child's roster. LPA reminded licensee of the requirement of having a complete and up to date child's roster. Licensee stated she will complete child's roster and submit proof to licensing.

On or before March 30, 2018, any person who works in a child care facility shall complete Mandated Reporter training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers. Licensee has not completed Mandated Reporter training. Licensee stated she will complete Mandated Reporter training and submit proof to licensing.



LPA reminded licensee day care needs to be operated within the limitations and capacity of a Large Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.

*CON'T ON PAGE 3*
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
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: COLLINS, YVETTE
FACILITY NUMBER: 073407132
VISIT DATE: 01/26/2023
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*PAGE 3*

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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) Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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 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

LPA Christina Watts informed Yvette Collins that this report dated 01/26/2023 documents 2 Type B citations. Type B citation(s) are a potential risk(s) to the health, safety, or personal rights of children in care.

Exit interview conducted and report was reviewed with the licensee, Yvette Collins. A notice of site visit was given and must remain posted for 30 consecutive days.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC809 (FAS) - (06/04)
Page: 10 of 10