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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013410104
Report Date: 04/18/2024
Date Signed: 04/18/2024 01:20:57 PM


Document Has Been Signed on 04/18/2024 01:20 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:PEREIRA, FRANSKINFACILITY NUMBER:
013410104
ADMINISTRATOR:PEREIRA, FRANSKINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 589-7074
CITY:SAN LORENZOSTATE: CAZIP CODE:
94580
CAPACITY:12CENSUS: 3DATE:
04/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:43 PM
MET WITH:Franskin PereiraTIME COMPLETED:
03:01 PM
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Licensing Program Analyst Sidney Cortez, met with licensee Franskin Pereria for an Unannounced Annual Random Inspection. Present for this visit was the licensee Franskin Pereira and 3 pre school age child (total of 3 children) The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 6:00AM until 7:00 PM, MONDAY-SATURDAY


This is a single story home which consists of a living/dining room, 3 bedrooms, a play room, 1 bathroom, kitchen, back yard and detached garage. The home is neat and clean with heating and ventilation for safety and comfort. The ON Limit areas/areas used for day care are the living/dining room, play room, bathroom, bedroom next to bathroom, and the back yard. The OFF LIMIT AREAS are bedroom at end of hallway, kitchen, detached garage, and storage shed in the back yard which will be inaccessible by closed and/or locked doors and visual supervision at all times. The ISOLATION AREA will be in the living room (sofa area). There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children. The heaters and/or fireplace are screened to prevent access by children. Per licensee, there are no firearms in the home.

The home has a working smoke detector, carbon monoxide detector, working telephone, and First Aid Kit. The home has a fully charged (3A40BC) fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The licensee CPR and First Aid certificate is current and expires (January 22, 2025). The licensee's mandated reporter training is complete and she received a certification of completion and will expire on Feb 2025. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on March 2024. 2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Sidney CortezTELEPHONE: (510) 295-5031
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
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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