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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408856
Report Date: 07/29/2019
Date Signed: 07/29/2019 01:07:20 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:EPPS, TRACYFACILITY NUMBER:
073408856
ADMINISTRATOR:EPPS, TRACYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(773) 719-1275
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:14CENSUS: 0DATE:
07/29/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TRACY EPPSTIME COMPLETED:
01:15 PM
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LPA Tasha Alexander met today with Tracy Epps for an ANNOUNCED PRELICENSING inspection. Applicant was the only one present for the inspection. The home is a two story house consisting of 4 bedrooms, 3.5 bathrooms, living room, kitchen, separate dinning room, family room, in-law suite, laundry room and garage. The family room, in-law suite/bathroom, kitchen and backyard will be used as the primary areas for day-care. The off limit areas will be the downstairs bedroom located near the front door, the bathroom, near the front door, the entire upstairs which includes the master bedroom/bath, upstairs hall bathroom, 2 guest bedrooms and laundry room. These areas will be inaccessible to children in care by closed and/or locked doors, visual supervision and a safety gate at the bottom of the stairs. Applicant owns the home; proof was shown. There is a 2A10BC fire extinguisher, working smoke detectors and working carbon monoxide detectors throughout the home; recommended periodic servicing. Per applicant, there is a firearm located in the home that is stored in the off limits upstairs master bedroom, under the bed in a locked gun box. The ammunition is stored separately in a trunk. There are no pools, hot tubs or other bodies of water at the home. All sharp knives, cleaning solutions and medications are inaccessible to children. First aid kit is available and complete. The isolation area for sick children will be the hallway that leads to the in-law suite/play room. outdoor play will be in the backyard. There are toys and play space available. Applicant was instructed to conduct and document periodic fire and disaster drills. Applicant was informed that baby walkers, exersaucers and baby bouncers are not allowed. Applicant has completed CPR and first aid training which expires in 11/4/20. Applicant has completed her 16 hours of health and safety training.

Mandated reporter and appeal rights were discussed. Licensing forms were reviewed and copies given to applicant. Applicant was instructed on the law establishing a $100 fine per day for adults who are living in the home or who are providing care who do not have fingerprint clearances. Applicant was also instructed on the law requiring notification to parents regarding exclusions.
All forms can be downloaded at www.ccld.ca.gov. www.myccl.gov for day-care updates.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019
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: EPPS, TRACY
FACILITY NUMBER: 073408856
VISIT DATE: 07/29/2019
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PER FIRE CLEARANCE- NO CHILDREN ALLOWED ON THE SECOND FLOOR OR IN THE GARAGE.

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

THERE ARE NO DEFICIENCIES CITED TODAY. THIS HOME WILL BE LICENSED FOR A LARGE FCCH AS OF TODAY 7/29/19.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019
LIC809 (FAS) - (06/04)
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