073408652-10-10-2019-02-CC-CACA-BGTPKS-20191010112336

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408652
Report Date: 10/10/2019
Date Signed: 10/10/2019 11:23:42 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:	MARS, PRISCILLA		FACILITY NUMBER:	073408652
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	10/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Priscilla Mars		TIME COMPLETED:	11:30 AM

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 Analysts (LPAs) Cherie Acosta and Brittany Newton conducted an unannounced ANNUAL/RANDOM and INCREASE IN CAPACITY inspection. The licensee received fire clearance for 14 children on 9/26/19. Present during today’s inspection was the licensee, her fingerprint cleared assistant, one infant, one preschool aged child and three school aged children in care. The home was toured for Health and Safety Inspection. On limits area consist of the first floor bedroom, first floor bathroom, dining room, family room, and the backyard. Off limits area consists of the garage, kitchen and the entire second level of the home which will be inaccessible by closed and/or locked doors and visual supervision. 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. LPA verified that the fire extinguisher 2A10BC 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 was reminded that children are not to be left in parked vehicles. 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.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

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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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: MARS, PRISCILLA	FACILITY NUMBER: 073408652
	VISIT DATE: 10/10/2019

NARRATIVE

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Children files were reviewed. Files reviewed contain children’s emergency information. The licensee has current CPR and First Aid which expires 9/22/21.

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.

The licensee has completed the required mandated training 5/5/18.

Information on safe sleep was provided and discussed with the licensee.

The home is approved for the requested increase of capacity to 14 children effective today 10/10/19.

There are no deficiencies cited during today’s inspection.
Exit interview was conducted with Priscilla Mars.
Licensee was provided a copy of the appeal rights.
Notice of Site visit was provided at the time of inspection and must remain posted for 30 days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

LIC809 (FAS) - (06/04)

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