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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407944
Report Date: 11/09/2021
Date Signed: 11/09/2021 09:49:18 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:HARRIS, INGE-LISAFACILITY NUMBER:
073407944
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
11/09/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Inge-Lisa HarrisTIME COMPLETED:
10:17 AM
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Licensing Program Analysts (LPAs) Melissa Domantay and Melissa Guirit conducted an unannounced inspection for this facility at 9:00am for an increase of capacity. LPAs met with licensee, Inge-Lisa Harris, and toured all areas on limits for children in care for a health and safety inspection. Also present at the time of this inspection were 2 children. The facility is within capacity. All adults present are background cleared.

The areas on limits for children in care are the living room, the kitchen and dining room area and the hall bathroom, front left bedroom, back right bedroom, and backyard. Garage is off limits to children in care. Off limits areas are made inaccessible by closed doors and visual supervision. There is one fireplace which is screened to prevent access. There are age appropriate toys and furnishings which appear free of broken/sharp pieces. Child safety fasteners are in place on cabinets and no hazardous items/toxins are observed to be accessible to children in care. Per licensee there are no firearms stored or present on the premises.

The back yard/play area is fully fenced and on limits to children in care with adult supervision present at all times that children are using the area. There are no pieces of high climbing equipment of swings present. There are no pets present. There are no pools, hot tubs or accessible bodies of water present.

The facility has a working smoke detector, working carbon monoxide detector and fully charged 3A40BC fire extinguisher. The facility submitted an application for an increase of capacity and received from the fire department clearance from the Contra Costa County Fire Protection Department on 09/15/2021 for a capacity of 14 children.

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SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Melissa DomantayTELEPHONE: 510-725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
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: HARRIS, INGE-LISA
FACILITY NUMBER: 073407944
VISIT DATE: 11/09/2021
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The applicant’s CPR and First Aid certificate is current and expires 2/18/2022. Licensee's Mandated Reporter training certificate expired 10/5/2021, per Licensee she will sign up for course 11/9/2021 and submit completed certificate to LPA Domantay. Licensee is in compliance with immunization requirements. Safety precaution in regards to COVID-19 were discussed and posters were posted on front door.

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

Licensee was reminded that all adults 18 and over living or working in the home, 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.

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.

No deficiencies observed at this visit. The licensee is now approved for an increase in capacity to operate as a large family day care home.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Inge-Lisa Harris

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Melissa DomantayTELEPHONE: 510-725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
LIC809 (FAS) - (06/04)
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