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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416289
Report Date: 03/22/2018
Date Signed: 09/27/2024 07:57:37 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: 4DATE:
03/22/2018
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Carmen Sims-HarperTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst Caroline Colson met with Carmen Sims-Harper and her assistant, Maria Robles, for an unannounced case management inspection. There are 2 infants and 2 preschool children present. A health and safety inspection was conducted.

Please see LIC 809 D for deficiency
SUPERVISORS NAME: Anika Evans
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 26 of 40
Document Has Been Signed on 09/27/2024 07:57 AM - It Cannot Be Edited


Created By: Caroline Colson On 03/22/2018 at 10:04 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: 03/22/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/29/2018
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.

N. Harper is an adult who doesn't have a criminal record clearance and lives at the facility. She is currently away at college and is at home during vacation breaks. A CIVIL PENALTY ASSESSMENT FOR 500.00 IS BEING ASSESSED.
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Licensee will have N. Harper obtain a criminal record clearance.

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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: 03/22/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2018


LIC809 (FAS) - (06/04)
Page: 27 of 40