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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416555
Report Date: 03/24/2023
Date Signed: 03/24/2023 10:59:26 AM

Document Has Been Signed on 03/24/2023 10:59 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:COULTER, UNAFACILITY NUMBER:
013416555
ADMINISTRATOR:COULTER, UNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 638-5271
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
03/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:14 AM
MET WITH:Una CoulterTIME COMPLETED:
11:09 AM
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An unannounced Required - 1 Year inspection was conducted by Licensing Program Analyst L. Dyer. LPA arrived at the facility at 8:14 a.m. The licensee was present with her husband and mother (cleared) and 1 preschool child. Facility is in compliance with licensed capacity and facility ratios. Phone number and e-mail address are current. Hours: 6:30 a.m. - 5:00 p.m.
At 9:21 a.m., the following was observed: the day care area of the home was inspected. Areas licensed for child care: living room, dining room and the bathroom. Off-limit areas will be made inaccessible to children by closed and/or locked doors; gates; and visual supervision.
The home was clean and orderly, with adequate heating and ventilation. There were safe, healthful and comfortable accommodations, furnishings and equipment available to children at the time of this inspection. There were a variety of books and toys for children's use. There was a working smoke detector (tested); carbon monoxide detector (tested); a fully charged 2-A:10-B:C fire extinguisher; and a first aid kit.
Licensee stated there were no firearms or bodies of water on the premises. Fireplace is blocked by play equipment. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Hazardous items are inaccessible to children. Children have not played outside recently due to rainy weather. Licensee takes children on walks.
Licensee currently has no infants in care, but LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep web page at:
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and- resources/safe-sleep as an additional resource. Safe Sleep Handouts were also given to the licensee. 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. The handout, "A Child Care Provider's Guide to Safe Sleep" was provided and discussed, along with the requirements for an Individual Infant Sleep Plan.
(continued)
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: COULTER, UNA
FACILITY NUMBER: 013416555
VISIT DATE: 03/24/2023
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Children sleep on cots. Licensee states sheets are replaced when soiled or wet, and individual bedding is only used by one child only. Bedding is washed weekly.
LPA reviewed personnel, facility, and children's records at 9:39 a.m. Licensees' CPR/First Aid expires October, 2023. Licensee's Mandated Reporter Training expires 11/1/24. Last disaster drill completed 10/26/22. Facility roster was current. Required postings are visible for public review. Children's files are complete. All adults meet criminal background clearance requirements.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500 maximum per day/per person will be assessed if this regulation is violated. Licensee was also reminded of the Department's Inspection authority, and the need to comply when notified that termination of an employee is necessary.
Also discussed with the licensee: supervision of children at all times; car seats and high chairs; Unusual Incident Reporting; changes in on-limit areas; construction work at facility; paying fees on-line; smoking; ill children in home, and the Guardian background check process.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Important E-mail Addresses:
Community Care Licensing General Information and Updates:www.ccld.ca.gov
Mandated Reporter Training:www.mandatedreporterca.com (every 2 years).
Guardian: background check process with self-service options: https://www.cdss.ca.gov/inforesources/ cdss-programs/community-care-licensing/caregiver-background-check/guardian

NO DEFICIENCIES CITED TODAY.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Una Coulter.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
LIC809 (FAS) - (06/04)
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