073408307-2-5-2020-02-CC-PPEN-BLHQQG-20200205112220

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408307
Report Date: 02/05/2020
Date Signed: 02/05/2020 11:22:27 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:	WALLE-ULLOA, MARTA		FACILITY NUMBER:	073408307
ADMINISTRATOR:	WALLE-ULLOA, MARTA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 610-1592
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94806
CAPACITY:	14	CENSUS: 10	DATE:	02/05/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Marta Walle-Ulloa		TIME COMPLETED:	11:20 AM

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) Paul Petersen conducted an unannounced random annual site inspection for this facility at 0905. LPA met with licensee, Marta Walle-Ulloa, who was present along with assistant, Cristina Ulloa, and 11 children in care consisting of four infants and seven preschool age children. Also present at LPA's arrival was resource and referral agency inclusion specialist, Joanna Funtila. The facility is within ratio and capacity. All required adults are background cleared and associated to this facility. Children are being supervised. At arrival, LPA observed three infant age children sitting in car safety seats in the dining room area of the facility. Per licensee, all three infants had recently arrived at the facility. LPA toured all areas of the facility on-limits to children in care for a health and safety inspection. On limits area are; the downstairs living room, family room, kitchen and dining area, classroom, nap room and hall bathroom and the upstairs crib room. Off limits areas are made inaccessible by closed doors or child safety gating and visual supervision. There is safety gating at the base of the stairs. There is one fireplace which is inoperable and per licensee will not be used. Per licensee there are no firearms present or stored on the premises. The facility has a working carbon monoxide detector, working smoke/fire alarms and a fully charged 3A40BC fire extinguisher. The outdoor patio/play area is fully fenced and on limits to children in care. There are no pieces of high climbing equipment or swings present. There are no pools, hot tubs or other bodies of water accessible to children in care. There are no hazardous conditions observed in the patio area. Continued on Page 2**************************************************************************************

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

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: WALLE-ULLOA, MARTA	FACILITY NUMBER: 073408307
	VISIT DATE: 02/05/2020

NARRATIVE

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LPA reviewed the facility and children's records including parents' rights forms, emergency ID forms and immunization records. Assistant has current CPR/First Aid certification which expires 09/2020. All required postings are present. The facility roster was made current during this inspection.

LPA reviewed with licensee the current Facility Personnel Report Summary and verified that all adults requiring background clearances are cleared and associated to this facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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

The Safe Sleep Awareness Campaign "New and Proposed Safe Sleep Regulations and Best Practices" was provided and reviewed. Licensee is encouraged to visit www.ccld.ca.gov for licensing regulations and forms. To sign up for quarterly updates contact: childcareadvocatesprogram@dss.ca.gov. Licensee is reminded that Mandatory Reporter Training is to be renewed every two years.

There were no deficiencies cited during this inspection. A notice of site visit was provided and is to remain posted for 30 days from today's date. A copy of this report is to be available in the facility records for a period of three years from today's date.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

LIC809 (FAS) - (06/04)

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