073407225-12-4-2019-02-CC-LCHW-BJK43E-20191204174437

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407225
Report Date: 12/04/2019
Date Signed: 12/04/2019 05:44:47 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:	MOLINA, EDITH		FACILITY NUMBER:	073407225
ADMINISTRATOR:	MOLINA, EDITH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 325-5733
CITY:	OAKLEY	STATE: CA	ZIP CODE:	94561
CAPACITY:	14	CENSUS: 8	DATE:	12/04/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	MOLINA, EDITH		TIME COMPLETED:	05:55 PM

NARRATIVE

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Licensing Program Analyst (LPAs) LaKeisha Chew and Cherie Acosta met with licensee Edith Molina, for an UNANNOUNCED RANDOM INSPECTION. Present during this inspection was fingerprint cleared Assistant Alondra Ancirarubio, and 8 preschool-age children. The LPAs was guided by licensee on tour of home for a Health and Safety Inspection. The home is two stories and met compliance standards with heating and ventilation for safety and comfort for children in care.

The ON LIMIT AREAS: the entire first level which consist of living room, dining room, kitchen, family room, bathroom, approved by fire inspector garage and playroom (school room in the garage) and fenced backyard. The fireplace in the family room has a glass screen to prevent access by children. The OFF-LIMIT AREAS: the entire second level of the home, which will be inaccessible by a barrier gate at the bottom of the staircase, and the laundry room which will be inaccessible by closed and/or locked doors and visual supervision.

The fully fenced backyard is free from defects and dangerous conditions. There is a shed in the backyard to the left side of the home and it is inaccessible to children in care. There is two fountains in the backyard LPAs ensured no standing water in the fountains. LPAs observed that there are no toxins or hazardous items accessible to children in care, today. The home has fully charged fire extinguishers 2A10BC in the playroom and 3A40BC in the school room, working smoke detector, carbon monoxide detectors, working telephone, and a fully stock First Aid Kit. The licensee CPR and First Aid certificates are current, expiring 01/26/2021. Mandated Reporter Training was completed on 11/12/2019, expiring on 11/12/2021.

Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drill last one being done on 10/15/2019. Six (6) Children files were reviewed and found to follow the Title 22 regulations LPAs reviewed and obtained a copy of Licensee facility roster. Licensee and assistant are in compliance with the New Immunization law which pertains to day care providers & employees. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.

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 and appeal rights provided.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Lakeisha Chew	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019

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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