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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416289
Report Date: 02/06/2018
Date Signed: 09/27/2024 07:57:35 AM

Document Has Been Signed on 09/27/2024 07:57 AM - 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:SIMS-HARPER, CARMENFACILITY NUMBER:
013416289
ADMINISTRATOR:SIMS-HARPER, CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 530-4745
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
02/06/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Carmen Sims-HarperTIME COMPLETED:
02:10 PM
NARRATIVE
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Licensing Program Analyst Caroline Colson met Carmen Sims-Harper and Maria Robles, her assistant, for an unannounced random annual inspection and a follow-up case management inspection. Investigator Michelle Humbert-Rico conducted an inspection on January 31, 2018 to obtain information from Ms. Sims-Harper. There are 4 infants and 5 preschool children present. The home was toured to conduct a health and safety inspection. Ms. Sims-Harper was informed of the new civil assessments of up to $500 per adult for not having cleared fingerprints on file (if needed) before contact with the day care children.

The home is a two story home. The home consists of a living room, dinning room, kitchen, six bedrooms, and two bathrooms, unfenced front yard and fenced backyard. The two bedrooms, one bathroom located upstairs and unfenced front yard are the off limit areas. Ms. Sims-Harper states that there are no firearms in home. First Aid Kit is available and complete. Ms. Sims-Harper has current pediatric First Aid and CPR certificates which expire on March 13, 2018. The backyard is fenced and will used for outdoor play. She has a outdoor cat, 6 rabbits and a dog. The isolation area is the living room. There are no pools, spas, hot tubs, fish ponds or similar bodies of water. All poisons, detergents, cleaning compounds and medications are stored in areas which are inaccessible to children. There are no fireplaces or open face heaters accessible to children. The home has a 3A40BC fire extinguisher, smoke detector and carbon monoxide detector. The home is clean and orderly with heating and ventilation. There is a gate at the bottom of the staircase which is to prevent the children from going to the second floor. Licensee is present and allowed LPA to inspect the entire facility. Children aren't left in parked vehicles. Each child has safe, healthful, comfortable accommodations, furnishings and equipment. The home has a current roster. Fire and Disaster Drills are conducted every six month and documented. Records were reviewed.

This facility is not providing Incidental Medical Services - IMS at this time. LPA discussed IMS services and the requirement to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417.

See LIC 809 C additional information
SUPERVISORS NAME: Anika Evans
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: SIMS-HARPER, CARMEN
FACILITY NUMBER: 013416289
VISIT DATE: 02/06/2018
NARRATIVE
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Licensee was asked to go to our website at www.ccld.ca.gov to ensure that she is informed of all new laws and regulations.

The mandated reporting course needs to be completed by March 30, 2018.

See LIC 809 D for deficiencies

The attached type A deficiencies are cited today and must be corrected by the due date. Notice of site visit was posted at the time of the inspection and must be posted for 30 days. An exit interview was conducted. Appeal rights were given and discussed. This report must be available for public review for 3 years.
SUPERVISORS NAME: Anika Evans
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2018
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Document Has Been Signed on 09/27/2024 07:57 AM - It Cannot Be Edited


Created By: Caroline Colson On 02/06/2018 at 11:38 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SIMS-HARPER, CARMEN
FACILITY NUMBER: 013416289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/13/2018
Section Cited
CCR
102370(d)(1)

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Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department.

B. Robles didn't have a criminal record clearance on January 31, 2018. A CIVIL PENALTY ASSESSMENT FOR 500.00 IS BEING ASSESSED.
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Licensee will ensure all staff obtain a criminal record clearance or not present during day care hours.

Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250.00 per violation and $100 per day until corrected.
Type A
02/13/2018
Section Cited
HSC
1596.885(c)

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Health and Safety Code Section 1596.885(c): Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the
facility or the people of this state.

B. Robles lied about an infant being present in the facility on January 31, 2018.
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Licensee will ensure that all adults working in the facility are honest with all individuals who work for or represent the department.

Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250.00 per violation and $100 per day until corrected.
Type A
02/13/2018
Section Cited
CCR102417(a)

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Operation of a Family Child Care Home. The licensee shall be present in the home and shall ensure that children in care are supervised at all times.

Licensee didn't realize the infant was left in another room on January 31, 2018.
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Licensee will view the supervision video at www.ccld.ca.gov. A written report will be sent to our department regarding the video.

Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250.00 per violation and $100 per day until corrected.
Type A
02/13/2018
Section Cited
CCR
102423(a)(2)

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Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishing and equipment.

An infant was left in a car seat on January 31, 2018.
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Licensee will ensure that children are taken out of their car seat once they enter the facility.

Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250.00 per violation and $100 per day until corrected.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Anika Evans
LICENSING EVALUATOR NAME:Caroline Colson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2018


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