013413981-8-15-2023-02-CC-CFES-CUQQRK-20230815122404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013413981
Report Date: 08/15/2023
Date Signed: 08/15/2023 12:25:41 PM

Document Has Been Signed on 08/15/2023 12:25 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	PENELTON, ROSALYN		FACILITY NUMBER:	013413981
ADMINISTRATOR:	PENELTON, ROSALYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 568-3421
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94603
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	08/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Rosalyn Penelton		TIME COMPLETED:	12:40 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 August 15 ,2023, at 9:45AM, Licensing Program Analysts (LPA's) Catherine Fernandes and Randall Dunevant conducted an unannounced Annual Inspection and met with Licensee Rosalyn Penelton. Residing in the home is the License. Present for this inspection was the Licensee, and two infants in care. Todays visit was to conduct a Health and Safety Inspection. Operation hours will be 7:45AM to 6:00PM Monday through Friday. The home is a single story home with three bedrooms and one bathroom. The entrance to the day care is the front door. The inside and outside of the home were observed to be neat, clean with age-appropriate materials and toys for the children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas by locks on cabinets. During today’s inspection, LPA observed the following precautions safety latches on the bathroom cabinets to prevent access, safety knob covers on the doors and gates throughout the home. Per applicant there is a firearm on property, LPAs observed the firearm and the ammunition to be locked and stored separately. There is a dog that lives in the home that is not around the children in care. LPA did not observe any bodies of water on or near the property. The on limit areas: are the living room which is the main area of the day care, the first bedroom on the left side of the hallway, the front yard, the driveway and bathroom. The off limit areas: are the master bedroom on the left side, the bedroom across from that bedroom, the kitchen, the laundry room, the backyard, the two sheds and the converted garage, which will be inaccessible by closed and/or locked doors,gates and visual supervision. The isolation area will be the on limit bedroom. The home has a fully charged 3A40BC fire extinguisher in the kitchen, a working smoke detector and carbon monoxide detector in the main area of the day care, and a working telephone. There is a fire place and a heater in the hallway that were observed to be covered and inaccessible to children in care. Report continues on 809C

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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: PENELTON, ROSALYN	FACILITY NUMBER: 013413981
	VISIT DATE: 08/15/2023

NARRATIVE

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The licensee conducts fire and disaster drills at least twice a year, the last drill was conducted on 7/18/2023. The licensee's has a valid CPR certificate that expires on 9/23/23. Licensee stated she has completed her Mandated Reporter training, however proof needs to be provided.
All present children's files were reviewed, and LPA's obtained a current children's roster.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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

Report continues on 809C.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: PENELTON, ROSALYN	FACILITY NUMBER: 013413981
	VISIT DATE: 08/15/2023

NARRATIVE

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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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Penelton, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Rosalyn Penelton

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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