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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408585
Report Date: 05/16/2019
Date Signed: 05/16/2019 03:52:10 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:KATO, AKIKOFACILITY NUMBER:
073408585
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
05/16/2019
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Akiko KatoTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Paul Petersen conducted an announced case management site inspection for an increase of capacity application on 05/16/19 at 1505. LPA met with and toured the facility with licensee, Akiko Kato. Also present are two napping children in care, consisting of one infant and one preschool age child. The facility recently passed fire inspection clearance by El Cerrito Fire Department and LPA has received the completed STD 850 from El Cerrito Fire verifying clearance. This facility had it's most recent annual site inspection in December 2018 and no deficiencies were cited during the inspection. All on limits areas for children are located on the lower level of the home. The on limits areas for children are the main classroom/day care room, the kitchen, the downstairs bathroom and the nap room/play room downstairs. The entire upper level of the home is off limits to children and is made inaccessible via a closed door at the base of the stairs. LPA and licensee reviewed the staffing ratios and capacity for a large family child care home. LPA and licensee also discussed staff requirements for immunization documentation and mandatory reporter training. Licensee has assistants employed and available for staffing needs. The facility is clean and organized with age appropriate furnishings and equipment which are in good condition. There are no hazardous items or toxins observed to be accessible to children in care. Licensee's CPR/First Aid certification is current. The outside play area is fully fenced and on limits to children in care. There is no high climbing equipment or swings present. There are no pools, hot tubs or other accessible bodies of water present. 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 For licensing forms and regulations visit www.ccld.ca.gov.

This facility is approved for increase of capacity effective immediately. A notice of site visit was provided and is to remain posted for 30 days. A copy of this report is to remain in the facility records for a period of three years from today's date.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
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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