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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408418
Report Date: 12/20/2019
Date Signed: 12/20/2019 11:30:10 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:PHELPS, TERESAFACILITY NUMBER:
073408418
ADMINISTRATOR:PHELPS, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 813-2498
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:14CENSUS: 7DATE:
12/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Teresa PhelpsTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced ANNUAL/RANDOM inspection. Present during today’s inspection was the licensee, her fingerprint cleared husband, fingerprint cleared assistant, one infant and six preschool aged children in care.

The home was toured for Health and Safety Inspection. On limits area consist of the living room (which has been converted into a playroom), dining room, family room, first floor bathroom, first floor bedroom located at the end of the hall, kitchen, and the backyard. Off limits area consists of the garage, first floor bedroom/office located at the beginning of the hallway, and the entire second floor. The home appears to be orderly, with heating and ventilation for safety and comfort. There are no pools, spas, hot tubs, or any other similar bodies of water at this home. There are no firearms on the premises as stated by the licensee. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored and inaccessible to children. Stairs are gated. The fireplace is screened to prevent access by children. The fireplace is not used during child care hours as stated by the licensee. LPA verified that the fire extinguisher 3A40BC is fully charged. The home is equipped with both a smoke detector and carbon monoxide detector. There is a working telephone in the home. The home provides appropriate toys, learning materials and play equipment. Outdoor play area is fenced.

The licensee is operating within the licensed capacity. LPA did not observe any child left without supervision during the inspection.

Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children or an immediate civil penalty can be assessed.

Children files were reviewed. Files reviewed contain children’s emergency information.
Licensee is in compliance with immunization requirements for child care providers.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: PHELPS, TERESA
FACILITY NUMBER: 073408418
VISIT DATE: 12/20/2019
NARRATIVE
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Fire and disaster drills are conducted at least once every six months.

The licensee was encouraged to email ChildCareAdvocatesProgram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

Safe sleep information was provided and discussed with the licensee.

At approximately 10:20am during file review the following deficiencies was observed:

-Licensee's CPR/First Aid expired 8/12/19

Exit interview was conducted with Teresa Phelps.
Licensee was provided a copy of the appeal rights.
Notice of Site visit was provided at the time of inspection and must be posted for 30 days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: PHELPS, TERESA
FACILITY NUMBER: 073408418
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/20/2020
Section Cited

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Personnel Requirements. The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to
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Health and Safety Code Section 1596.866. This requirement was not met as evidenced by: licensee's CPR/First aid expired 8/12/19, which poses a potential risk to the health and safety of children in care
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2019
LIC809 (FAS) - (06/04)
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