214005375-12-1-2022-05-CC-HLEG-CLPRKU-20221201120608

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005375
Report Date: 12/01/2022
Date Signed: 12/01/2022 12:06:49 PM

Document Has Been Signed on 12/01/2022 12:06 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	CARRIER, KATHLEEN R.		FACILITY NUMBER:	214005375
ADMINISTRATOR:	CARRIER, KATHLEEN R.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 378-4371
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	14	CENSUS: 4	DATE:	12/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:03 AM
MET WITH:	Kathleen Carrier		TIME COMPLETED:	12:20 PM

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On 12/1/2022, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced annual visit to the Kathleen Carrier facility. The LPA was granted entry by the Licensee, Kathleen Carrier. The LPA explained the purpose of the visit to the licensee. Guardian, the department's system for conducting background checks, has confirmed that all the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPA observed the licensee and her assistant supervising four infants. Children's capacity and ratio requirements were observed to be in compliance. During the visit, the LPA observed that there were two dogs in the facility.

Day-care Area(s): Front living room, Kitchen/Dining area, Son's bedroom, Hall bathroom and Backyard.

Off Limit Area(s): Back living room, Master bedroom and bathroom and Front bedroom. All off-limit area(s) are secured with a locked door or a safety gate. The licensee understands that off-limits areas may not be used for childcare during business hours.

The LPA and the licensee both performed careful inspections of the day-care facilities to look for any potential health and safety hazards. Toys and equipment that are suitable for children of the proper age range are provided at the day-care. The building has sufficient lighting and ventilation, and it is free of any defects or conditions that could put the children in its care in risk. The facility is equipped with a first aid kit that is completely loaded with everything that is required for the treatment of injuries. The day-care facility is equipped with a smoke detector, a carbon monoxide detector, and a fire extinguisher that is always ready for use. Every garbage can and power outlet has been covered. Products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of their reach. The LPA did not find any walkers, bouncers, or other comparable objects during its inspection.

There are reportedly no firearms or other weapons on the premises, as stated by the licensee.

The LPA found that the facility has a swimming pool that is surrounded by a fence.

***See Page 2 for continuation***

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CARRIER, KATHLEEN R.	FACILITY NUMBER: 214005375
	VISIT DATE: 12/01/2022

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Continued, Page 2
The LPA observed that the facility had posted all the required forms, including the facility license, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The licensee is aware that smoking is not permitted in a family childcare facility.

The LPA reviewed the records of four children. All required forms were in the children’s’ file.

The LPA reviewed the records of the licensee and her assistant. All required forms were in the files of the licensee and her assistant. Review of the training records shows that the licensee is current with her Pediatric First Aid / CPR certifications.

According to the licensee, the facility satisfies the requirements by carrying out simulations of fire and earthquake drills twice a year, as well as by documenting their results.

The following reminders were discussed with the licensee.

1. 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.
2. Incidental Medical Services (IMS) policy
3. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.
4. Regulations for safe sleeping in accordance with the Health and Safety Code.
5. Checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/

No deficiencies were issued today

A copy of this report, and the “Notice of Site Visit” were given to the licensee.

A “Notice of Site Visit” must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with the Licensee, Kathleen Carrier

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

LIC809 (FAS) - (06/04)

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