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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418757
Report Date: 04/03/2023
Date Signed: 04/03/2023 12:25:03 PM

Document Has Been Signed on 04/03/2023 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:FERNANDEZ, TERESAFACILITY NUMBER:
013418757
ADMINISTRATOR:FERNANDEZ, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 457-3477
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Teresa Fernandez TIME COMPLETED:
12:45 PM
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On April 3, 2023 Licensing Program Analyst (LPA) Lorraine Dacanay Breaux conducted an unannounced 1 year required annual inspection. Present during today’s inspection was the licensee, Teresa Fernandez. Hours of operation are Monday – Friday 8:00 AM - 6:00 PM. There were no children in care for today visit, due to being closed for vacation.

The home was toured for Health and Safety Inspection. This is a single story home. ON LIMITS: area consist of the kitchen, dining room, living room, family room, both bathrooms and master bedroom (off dining area) bedroom on the right in the hallway, front and rear yard. OFF LIMITS: The bedroom on the right of the hallway, laundry room and garage. Isolation Area: Is the master bedroom (office) away from children in care. There are no firearms on the premises as stated by the licensee. All required posting are posted for public viewing. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored and made inaccessible to children in care. The fireplace is barricaded to prevent access by children. LPA verified that the fire extinguisher is fully charged 3A40BC. The home is equipped with both a smoke detector and carbon monoxide detector (tested). There is a working telephone in the home. The home provides appropriate toys and play equipment. Outdoor play area is fully fenced. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection.

LPA requested and reviewed the files of children in care. All children files contain Immunization, Parent's Rights, and Medical Consent forms. The facility roster was reviewed, and copies were obtain. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 02/28/23.The licensee has current CPR and First Aid which expires April 10, 2024. The licensee is in compliance with the immunization laws which pertains to all childcare providers. All required forms are posted and visible for public review.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: FERNANDEZ, TERESA
FACILITY NUMBER: 013418757
VISIT DATE: 04/03/2023
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California Law requires Child Care homes licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

LPA discussed the safe sleep regulations with facility representative 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 facility representative 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 Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 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: http://www.ada.gov/childqanda.htm.

Licensee [or facility representative] 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 $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Licensee has current CPR/First Aid which expires April 10, 2024.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: FERNANDEZ, TERESA
FACILITY NUMBER: 013418757
VISIT DATE: 04/03/2023
NARRATIVE
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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/process.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights Provided. Exit interview conducted and report was reviewed with the licensee [or facility representative] Teresa Fernandez.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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