073408651-9-23-2022-02-CC-CWAS-CJJVS8-20220923164108

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408651
Report Date: 09/23/2022
Date Signed: 09/23/2022 04:41:23 PM

Document Has Been Signed on 09/23/2022 04:41 PM - It Cannot Be Edited

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:	MATTOS, ANGEL M		FACILITY NUMBER:	073408651
ADMINISTRATOR:	MATTOS, ANGEL M		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 586-6834
CITY:	OAKLEY	STATE: CA	ZIP CODE:	94561
CAPACITY:	14	CENSUS: 7	DATE:	09/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Angel Mattos		TIME COMPLETED:	04:50 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	On 09/23/2022 at 2:00 PM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced annual inspection for Angel Mattos's large family child care home. LPA met with licensee and guided analyst on a tour of the facility. During today's inspection, there were 7 children in care (2 infants, 3 preschool aged and 2 school aged)and with an aid who is fingerprint cleared and licensee 15 year old minor child. There are currently 13 children enrolled in the facility. Family members residing in the home are licensee, licensee husband and licensee 15 year old minor child. Facility hours of operations are Monday - Friday from 7:00 AM - 5:30 PM. This is a one story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, attached garage, and fenced backyard. Licensee stated she would like to make 1 bedroom off limits. The children on limits areas: Living room, dining room, kitchen, 1 bedroom, and the middle of backyard. Areas off limits include: 2 bedrooms, master bathroom, attached garage, and the left and right side of the backyard. The LPA toured all areas used by children during this visit. Per licensee, there are no dangerous weapons or firearms in the home. Licensee has an up to code 3A40BC fire extinguisher and working smoke/carbon monoxide detector on the premises. LPA observed a gate around the fireplace in the living room. Licensee last conducted fire drill 06/15/2022. Currently, there is 2 dog, 1 cat and 7 chickens in the facility. Facility does provide transportation for children however licensee understands that children cannot be left alone unattended in parked vehicles.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina Watts	TELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

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: MATTOS, ANGEL M	FACILITY NUMBER: 073408651
	VISIT DATE: 09/23/2022

NARRATIVE

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LPA inspected the backyard and observed age appropriate toys for children to play with. On the right side of the backyard is a chicken coop with 7 chicken in off limit area. On the left side of the backyard is an outdoor area for licensee 2 dogs which is also in an off limits area. LPA observed a locked shed that is made inaccessible to children in care with a fence. LPA discussed with licensee that there needs to be 100% supervision when children are playing in the backyard.

Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The licensee Pediatric First Aid and CPR certificate will expire in 10/2023. Required postings were observed near the entrance.

LPA reminded licensee day care needs to be operated within the limitations and capacity of a Large Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating system for safety and comfort. There were safe toys, play equipment and materials observed for children. There are no stairs in the home. There is a working telephone in the home. Detergents, poisons, cleaning compounds, medications, and other items which can pose a danger to children are made inaccessible in the home.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina Watts	TELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

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: MATTOS, ANGEL M	FACILITY NUMBER: 073408651
	VISIT DATE: 09/23/2022

NARRATIVE

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On or before March 30, 2018, any person who works in a child care facility shall complete Mandated Reporter training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers. Licensee has provided Mandated Reporter certificate and the certificate will expire 12/2022.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

As of 09/23/2022, 1 bedroom will now be considered off limits to children in care.

In the areas that were evaluated, there were no violation observed.

Exit interview conducted and report was reviewed with the licensee, Angel Mattos. A notice of site visit was given and must remain posted for 30 consecutive days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina Watts	TELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

LIC809 (FAS) - (06/04)

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