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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413556
Report Date: 04/19/2023
Date Signed: 04/19/2023 02:30:39 PM


Document Has Been Signed on 04/19/2023 02:30 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:LAMA, DIKIFACILITY NUMBER:
434413556
ADMINISTRATOR:LAMA, DIKIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 529-8056
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94043
CAPACITY:14CENSUS: 7DATE:
04/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Erika LamaTIME COMPLETED:
01:15 PM
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On 04/19/2023 at 10:00am Licensing Program Analyst (LPA) Christina Uribe, met with fingerprint cleared facility representative (licensee's daughter), Erika Lama for an UNANNOUNCED ANNUAL INSPECTION. Present for the inspection were 7 daycare children and 1 fingerprint cleared assistant (Bhim Gurung). The licensee is in ratio and capacity compliance today as the children present are 4 infants and 3 preschool-aged. The licensee was not present at the time of the inspection due to needing to be at the hospital for today with her mother. Upon arrival LPA provided licensee a copy of the Entrance Checklist (LIC 126). The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday-Friday 8:00am-6:00pm.

The home is a single story home with 3 bedrooms, 2 bathrooms, living room, kitchen, dining area, front yard and back yard. LPA observed the home to be neat and clean with central heating and ventilation for safety and comfort. All on/off-limit areas are consistent with the facility's pre-licensing reports.

The OFF-LIMIT AREAS are 2 bedrooms, 1 bathroom, back yard, and side yard and will be inaccessible to children by locked doors, safety gates and visual supervision.

The ON-LIMIT AREAS are 1 bedroom, 1 bathroom, living room, kitchen, dining room, & front yard. The front yard is fully fenced, shaded, and play equipment is in safe and good condition.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, carbon monoxide detector, telephone and fully stocked first aid kit. There are no pools, hot tubs or any other bodies of water present at the time of the inspection. Per licensee, there are no firearms or pets on the premises.

Page 1 of 3 ***Continued on LIC 809C***

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2023
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 6


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LAMA, DIKI
FACILITY NUMBER: 434413556
VISIT DATE: 04/19/2023
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The licensee completed the Health and Safety training, CPR/First Aid certification expires on 07/12/2023. Both assistants also have a current Pediatric CPR/First Aid Certification which expire on 07/12/2023. Licensee and both assistants have Mandated Reporter certificates which expired recently two months ago and these certificates need to be renewed immediately.

The licensee conducts and documents fire and disaster drills at least twice a year and the last conducted drill was on 02/17/23. All required forms are posted and visible for public review.

LPA Uribe reviewed 7 children’s files and personnel records. Sleep Charts for sleeping infants were reviewed and within compliance of the Safe Sleep Regulations. There is a current roster available for review. The facility does not have liability insurance and Affidavit Regarding Liability Insurance forms (LIC 282) were reviewed.


Incidental Medical Services (IMS) policy was discussed and the facility does not have any children with the need for medication to be kept at the facility at this time. 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders, by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email notifications.

Facility representative 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.

Page 2 of 3 ***Continued on LIC 809C***

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LAMA, DIKI
FACILITY NUMBER: 434413556
VISIT DATE: 04/19/2023
NARRATIVE
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LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative 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.

Effective August 1, 2003 California Law requires Child Care Licensees 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 to the regional office by phone and the written report, LIC 624, within 7 business days.

No deficiencies found during today's inspection. Please see advisory note pages and list below for technical violations issued today:

  • Technical Violation: Mandated Reporter certificates are recently expired and need to be renewed.
  • Technical Violation: Some children's files had missing or incomplete Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) forms.
  • Technical Violation: Some children's files need an updated copy of their immunization records from their physician's office.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Erika Lama.

Page 3 of 3 ***End of Report***

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023
LIC809 (FAS) - (06/04)
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