073407990-2-18-2020-02-CC-LCHW-BLX5SX-20200218191328

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407990
Report Date: 02/18/2020
Date Signed: 02/18/2020 07:13:43 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:	DE LA ROSA, ANGELA		FACILITY NUMBER:	073407990
ADMINISTRATOR:	DE LA ROSA, ANGELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	9256255280
CITY:	OAKLEY	STATE: CA	ZIP CODE:	94561
CAPACITY:	14	CENSUS: 4	DATE:	02/18/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	DE LA ROSA, ANGELA		TIME COMPLETED:	04:45 PM

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Licensing Program Analyst LaKeisha Chew met with licensee Angela De La Rosa, for an unannounced Required inspection. Present during the inspection was 4 children in care (one (1) preschool and three (3) school-age) which includes the licensee school-age child. The home was toured to conduct a Health and Safety Inspection.

This is a two story 5 bed, 3.5 bathroom home. The home met safety and comfort regulation for heating and ventilation. The on-limit area consist of the formal living room, formal dining room (classroom/playroom), family room, first floor bathroom, kitchen, loft and the center portion of the backyard only.

The off-limit area consists of the garage, first floor bedroom, laundry room, second level bathrooms, bedrooms., and linen closet, which will be inaccessible by closed and/or locked doors, barrier gate and visual supervision.

Licensee is reminded the children in care are to be escorted up and down the stairs. The barrier gate at the bottom of the staircase is to remain in place during childcare operation hours. The Isolation area is the formal dining room (playroom). The backyard is fully fenced and is free from defects and dangerous conditions. The swimming pool is to the right of the backyard which is off limits to children in care. The left side of the backyard is also off limits to children in care. All hazardous materials and toxins are kept out of the reach of children.

The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and first aid kit. The licensee. The fireplace in the family room is screened to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year last being conducted on 10/23/19.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Lakeisha Chew	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020

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: DE LA ROSA, ANGELA	FACILITY NUMBER: 073407990
	VISIT DATE: 02/18/2020

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CPR and First Aid certificate is current. Children files were reviewed and found to be in compliance with the Title 22 regulations. LPA reviewed the facility roster and obtain a copy.

The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.

There are no deficiencies cited today

An exit interview was conducted.

A notice of site visit was posted.

LPA advised licensee of the requirement to post the notice of site visit for 30 days

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Lakeisha Chew	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020

LIC809 (FAS) - (06/04)

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