010214703-6-10-2021-52-CC-BPLY-C3UPSB-20210610113404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010214703
Report Date: 06/10/2021
Date Signed: 06/10/2021 11:34:10 AM

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	CAMERON, COSSETTE & WILLIAM		FACILITY NUMBER:	010214703
ADMINISTRATOR:	CAMERON, COSSETTE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 881-8603
CITY:	CASTRO VALLEY	STATE: CA	ZIP CODE:	94546
CAPACITY:	12	CENSUS: 4	DATE:	06/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Cossette Cameron- Licensee		TIME COMPLETED:	11:45 AM

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On 6/10/21, Licensing Program Analyst (LPA) B. Plumboy conducted an unannounced ANNUAL/RANDOM inspection. Present during the inspection was the licensee, Cossette Cameron with 4 children (2 infants and 2 preschool age children). The home was toured for Health and Safety Inspection. This facility currently operates from Monday through Friday, 7:30am until 6:00pm.

The OFF LIMITS area is the garage. There is a swimming pool in the backyard with a fence surrounding the area and self latching gate. There is also another gate on the bottom stairway leading up to the pool. There are no firearms on the premises as stated by licensee. All the cleaning products during the inspection were observed to be stored and made inaccessible to the children. The fireplace is barricaded with a glass door and is not currently being used by the licensee. LPA inspected and verified that the fire extinguisher 3A40BC is fully charged, carbon monoxide detector, smoke detector and home phone are in working condition. Backyard play area is properly fenced and there are toys available for children to use during today's inspection. There are toys, learning materials and kids furniture that appeared to be well maintained during today's inspection. The licensee has completed the required training on preventive health practices including pediatric CPR and First Aid which expires on 4/17/23. Children's roster is current and available. Fire and disaster drills are being conducted regularly with the last one conducted on 05/05/21 with 7 children. Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children or an immediate civil penalty can be assessed. The licensee is in compliance with the immunization law.

See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: CAMERON, COSSETTE & WILLIAM	FACILITY NUMBER: 010214703
	VISIT DATE: 06/10/2021

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The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

California Law requires Family Child Care Home 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 by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

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. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

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

No deficiencies cited during today's inspection. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

LIC809 (FAS) - (06/04)

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