073408344-1-31-2020-02-CC-PPEN-BLCSDN-20200131124725

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408344
Report Date: 01/31/2020
Date Signed: 01/31/2020 12:47:32 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:	GALVEZ, NYISHA		FACILITY NUMBER:	073408344
ADMINISTRATOR:	GALVEZ, NYISHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 417-2460
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94803
CAPACITY:	14	CENSUS: 9	DATE:	01/31/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Nyisha Galvez		TIME COMPLETED:	12:50 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) Paul Petersen conducted an unannounced random annual site inspection for this facility at 1040. LPA met with licensee, Nyisha Galvez, and toured all areas on limits to children in care for a health and safety inspection. Also present during this inspection were assistant, Aaliyah Geddins, and nine children in care including two infants and seven preschoolers. The facility is within ratio and capacity. All children are being supervised. Licensee's husband, William Galvez, was also present in the residence. All adults present are background cleared and associated to this facility. The On Limits areas are the living room, kitchen and dining area, the hall bathroom, and the converted sun room. Off limits are made inaccessible by closed doors and visual supervision. Child safety fasteners are used on drawers and cabinets. No hazardous items/toxins were observed to be accessible to children in care. There is a working carbon monoxide detector, working smoke alarm and fully charged 3A40BC fire extinguisher. Per licensee the facility had a fire department inspection within the past six months. There are age appropriate furnishings, equipment and play items that are free of sharp/broken pieces. Per licensee, there are no firearms present or stored on the premises. The fireplace is screened to prevent access by children. The sun room has a portable air conditioning unit for temperature management. The home has heating and ventilation for safety and comfort. Children's files were reviewed for parent's rights forms, identification and emergency information forms and immunization records. The facility roster is current. All required postings are present. 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: 01/31/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020

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: GALVEZ, NYISHA	FACILITY NUMBER: 073408344
	VISIT DATE: 01/31/2020

NARRATIVE

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Staff records were reviewed for background clearances, immunization records and CPR/First Aid. Assistant and licensee have current CPR/FIrst Aid which expires 02/21.

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

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 the Mandatory Reporter Training is due to be completed for all child care staff every two years. The Safe Sleep Regulations for infants was reviewed and provided to licensee.

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

There were no deficiencies cited during this inspection. A copy of the appeal rights was provided and a notice of site visit was printed and posted and is to remain posted for a period of 30 days. A copy of this report is to be available in the facility records for 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: 01/31/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020

LIC809 (FAS) - (06/04)

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