073409126-3-26-2021-02-CC-LDYN-BZGSYU-20210326141807

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409126
Report Date: 03/26/2021
Date Signed: 03/26/2021 02:18:22 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:	ALLEN, MELISSA		FACILITY NUMBER:	073409126
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	03/26/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Melissa Allen		TIME COMPLETED:	02:20 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 3/26/21 at 12:35pm, Licensing Program Manager (LPM) Loretta Dyson conducted a prelicensing inspection with the applicant, Melissa Allen. The applicant's husband was also present. The applicant submitted an initial application for a small family child care home license. The facility will operate Monday-Friday 7:30am-5:30pm. A tour of the home was completed to conduct a health and safety inspection. The home is a single story home which consists of two bedrooms, office, two bathrooms, kitchen, living room, dining room, child care room (sun room), and garage. The on limit areas include the children's bedroom, hallway bathroom, kitchen, dining room and child care room. All other areas are off limits and made inaccessible by gate, closed and/or locked doors and visual supervision. The isolation area will be the children's bedroom, away from other children in care. LPM observed that the home is neat and clean and has sufficient heating and ventilation. LPM observed an ample supply of age appropriate furniture, toys and activities. LPM did not observe any bodies of water, toxins or hazardous items that would be accessible to children. The backyard is fully fenced and LPM advised the applicant to keep an eye on children going up and down the slope, but did not observe any defects of dangerous conditions. The fireplace is located in the living room, which is off limits and inaccessible to children with a gate. There are no firearms in the home, per the applicant. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and first aid supplies. The applicant has completed the required preventative health and safety training, which includes the nutrition and lead poisoning prevention requirements, and has a current CPR/First Aid certificate that expires on 10/23/22. LPM verified that the applicant has all of the required postings, including the COVID-19 postings. The applicant was reminded to ensure that parents have access to the information. LPM reviewed safe sleep regulations and advised the applicant that a pack-in-play should only be for play and not sleep. A brochure regarding safe sleep was provided.

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

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: ALLEN, MELISSA	FACILITY NUMBER: 073409126
	VISIT DATE: 03/26/2021

NARRATIVE

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The applicant is reminded of the following: to review and follow COVID-19 guidelines, to ensure that all adults receive the required criminal record clearance and are associated to the license, prior to living or working in the home or visiting for an extended time, and to report any injuries or unusual incidents, including COVID-19 exposures and positive results at the facility. The applicant is advised to review licensing regulations and guidelines, including the Provider Information Notices (PINs) on the website www.ccld.ca.gov and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocates@dss.ca.gov. LPM reviewed the COVID-19 Assessment with the applicant, and it has been completed.

Incidental Medical Services (IMS) policy was discussed. 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.

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. LPA reviewed the individuals associated to the license, and the licensee confirmed that everyone who is required to have a criminal record clearance is associated. Licensee was reminded of the responsibility as a mandated reporter. The licensee was reminded that the mandated reporter training needs to be renewed every 2 years, at www.mandatedreporterca.com.

LPM reviewed the ratio and capacity for a small family child care home license, and reminded the applicant to adhere to these requirements at all times.

This home will be licensed effective today, 3/26/21. An exit interview was conducted with the applicant. This report will remain on file for 3 years.

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

LIC809 (FAS) - (06/04)

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