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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408585
Report Date: 01/29/2020
Date Signed: 01/29/2020 09:49:31 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:KATO, AKIKOFACILITY NUMBER:
073408585
ADMINISTRATOR:KATO, AKIKOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 359-8951
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY:14CENSUS: 5DATE:
01/29/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Akiko KatoTIME COMPLETED:
10:15 AM
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On 01/29/2020, Licensing Program Analyst (LPA), Melissa Guirit, met with licensee Akiko Kato for an UNANNOUNCED RANDOM INSPECTION. Present for this inspection were licensee, five preschoolers, and fingerprint cleared assistant, Kai and Koto. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are from 8:30 AM to 5:30 PM.

The home is two story. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the lower level bedroom (nap room), half bathroom, kitchen, living room (main play area), and back yard. The OFF LIMIT AREAS are the entire upstairs, and lower level office with attached bathroom which will be inaccessible by closed and/or locked doors, safety gate, and visual supervision. The ISOLATION AREA will be in the nap room. The outdoor play area is free from defects or dangerous conditions and is completely fenced with 100% supervision. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today.

The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and fully stock First Aid Kit. The licensee CPR and First Aid certificate is current and expires 03/16/2021 . Licensee completed the Mandated Reporter Training which expires on 02/07/2021. Licensee is in compliance with the new immunization law. The lower level of the home that are on limits to children has no fireplace or exposed heater vents. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year.

See 809-C for continuance.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa GuiritTELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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: KATO, AKIKO
FACILITY NUMBER: 073408585
VISIT DATE: 01/29/2020
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At 9:10AM, (5) Children files were reviewed, facility roster reviewed and copy obtained. All reviewed children's files contained updated immunization records and signed Prarents' Rights. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov .http://www.myccl.gov/

Incidental Medical Services (IMS) policy was discussed.

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and appeal rights provided.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa GuiritTELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
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