073407622-7-18-2019-02-CC-GRED-BE7SRY-20190718140708

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407622
Report Date: 07/18/2019
Date Signed: 07/18/2019 02:07:21 PM

COMPREHENSIVE INSPECTION

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:	ROSS, MA. GABRIELLA		FACILITY NUMBER:	073407622
ADMINISTRATOR:	ROSS, MA. GABRIELLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 768-3099
CITY:	CONCORD	STATE: CA	ZIP CODE:	94520
CAPACITY:	14	CENSUS: 6	DATE:	07/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	ROSS, MA. GABRIELLA, LICENSEE		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 (LPA) Redmond arrived at the facility to conduct an unannounced, Annual/Random inspection visit on 07/18/19 at 12:20 PM. On this date, LPA met with ROSS, MA. GABRIELLA, LICENSEE. Capacity: The facility operates as a Family Day Care (large) and is licensed for fourteen (14) children. On this date, there are six (6) children present including four (4) infants. The Licensee utilizes a family member to assist with providing care and supervision to the children. The facility is in compliance with staff to child ratios. The facility is separated into the following designated areas include allowing children in and restricting children from these areas respectively: "On Limit" (areas accessible to children in care) include: · Family room · Bathroom – when children are toilet trained · Hall – (to access restroom) · Backyard (barricaded by fence) – currently not is use as PG&E is cutting trees "Off Limit” (areas inaccessible to children in care): · Private bedrooms · Kitchen · Restroom (no children are toiled trained)

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

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: ROSS, MA. GABRIELLA	FACILITY NUMBER: 073407622
	VISIT DATE: 07/18/2019

NARRATIVE

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Emergency Preparedness/Safety: There is a smoke detector, which, LPA tested and found operable. The fire extinguisher is fully charged and has a classification of 2 A 10 B:C. Emergency Disaster Plan was last updated on 09/17/12 and is current, per Licensee. Emergency earthquake/fire drills was last conducted in 09/2013 and exceed six month requirement, advisory given. First aid supplies available. Facility utilizes a cellular (and land-line) telephone line for telephone service. There are no hot tubs or other bodies of water. There are no firearms, per the Licensee. Per Licensee, she is not providing *Incidental Medical Services (IMS) services currently. An IMS plan must be submitted to LPA if Licensee intends to provide IMS in the future. Licensee is currently providing care for infants and is aware of Safe Sleep regulations. There are pack and play type sleep devices for infants in care.

Records Review

LPA reviewed records and determined that the Licensee and staff/volunteers have criminal background clearances and are associated to the facility. The Licensee has current pediatric first aid and CPR certification which expires on 01/28/18. The Licensee and assistant completed Mandated Reporter training on 08.02/18.

Postings: Facility License, Emergency Disaster Plan, Notification of Parent's Rights, Earthquake Preparedness Checklist. California Passenger Safety. Not Posted: If You See Something, Say Something, advisory given.

NO DEFICIENCIES CITED ON THIS DATE

Exit interview conducted. This Facility Evaluation Report and Notice of Site Visit issued and discussed with Licensee signature obtained below. Notice of site visit shall be posted remain posted for 30 days. Failure to keep this notice posted for the 30 consecutive days will result in an immediate $100 civil penalty. A copy of this report shall be available for 3 years and provided to parents/others upon request.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

LIC809 (FAS) - (06/04)

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