073408782-12-15-2022-02-CC-CFES-CM65C5-20221215184947

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408782
Report Date: 12/15/2022
Date Signed: 12/15/2022 06:50:17 PM

Document Has Been Signed on 12/15/2022 06:50 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:	SERVICE, MICHELLE		FACILITY NUMBER:	073408782
ADMINISTRATOR:	SERVICE, MICHELLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 360-0274
CITY:	PLEASANT HILL	STATE: CA	ZIP CODE:	94523
CAPACITY:	14	CENSUS: 12	DATE:	12/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:57 PM
MET WITH:	Michelle Service		TIME COMPLETED:	07:00 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 12/15/2022 at 2:57pm, Licensing Program Analyst (LPA) Catherine Fernandes met with Licensee Michelle Service for an Unannounced Required Annual Inspection. Present during the inspection were licensee's fingerprint cleared husband and fingerprint cleared helper. There were four infants and eight preschoolers in care. Residing in the home is Licensee and her fingerprint cleared husband. Licensee’s home was toured for a health and safety inspection. The facility operates 7:30am – 5:30pm, Monday - Friday. The home is a single-story home that consists of four bedrooms and two bathrooms. The entrance to the day care is on the left side of the garage. The inside and outside of the home were observed to be neat, clean with age appropriate materials and toys for the children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. During today’s inspection, LPA observed the following precautions, there is a fireplace in the main living room that is covered, there are gates to block off the kitchen area and the front door, there are safety latches on observed plugs in the home and there are patio stairs that are blocked off with a gate. Licensee has stated that there are no firearms in the home. There are two chickens in the backyard on right side of the yard that are fenced off. LPA did observe a water fountain and two ponds in the front yard that is off limits to the children in care. ON LIMITS AREA: the converted bedroom near the kitchen which is one of the main areas, the first bedroom on the left side of the hallway, the kitchen, the living/dining room, the breakfast nook, the enclosed backyard, the patio/outdoor classroom, both bedrooms at the end of the hall, the two bathrooms and the area where the chickens are located. OFF LIMITS AREA: the garage, both red sheds in the backyard, an area of left side of the yard that is fenced off, and the front yard, which will be inaccessible by closed and/or locked doors or visual supervision. ISOLATION AREA: living Room

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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: SERVICE, MICHELLE	FACILITY NUMBER: 073408782
	VISIT DATE: 12/15/2022

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
26
27
28
29
30
31
32

The home has a fully charged 3A40BC fire extinguisher located on the wall next to the entrance of the day care, a working smoke/carbon monoxide detector in the living room and a working phone. All required forms are posted and visible for public view by the entrance of the day care. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 9/8/2022. The Licensee's CPR and First Aid certificate is current and expires on 10/29/24. The Licensee was reminded of the responsibility as a mandated reporter and has provided proof of the required training for which was conducted on 9/30/21. LPA reviewed five the children’s files, four staff files and obtained the facility roster, all were complete and current.

Licensee was reminded that California Law requires Licensee to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

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) 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. As of right now the home is not providing IMS.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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: SERVICE, MICHELLE	FACILITY NUMBER: 073408782
	VISIT DATE: 12/15/2022

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
26
27
28
29
30
31
32

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.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep web page 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.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted

Report and Appeal Rights provided

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3