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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418757
Report Date: 07/01/2024
Date Signed: 07/01/2024 12:57:40 PM


Document Has Been Signed on 07/01/2024 12:57 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:14CENSUS: 5DATE:
07/01/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Teresa FernandezTIME COMPLETED:
01:20 PM
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On July 1, 2024 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 and 5 preschool age children in care. Hours of operation are Monday – Friday 8:00 AM - 6:00 PM.

The home was toured for Health and Safety Inspection inside and out. This single-story home was clean and orderly, with (centralized) heating and ventilation for the safety and comfort.

ON LIMITS: 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.
Licensee is reminded that 100% supervision in required when children are in the front yard, since it is not fully fenced.
OFF LIMITS: Bedroom on the right of the hallway, laundry room and garage. Isolation Area: Is the master bedroom away from children in care. Per licensee are no firearms on the premises as stated by the licensee. Per licensee does not provide overnight care, licensee confirmed that she resides in the home. 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. Licensee confirmed there are no pools/hot tubs at the home. Licensee does have insurance LPA reviewed and expires on 7/22/24.

809-C
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024
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: 07/01/2024
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The OUTDOOR PLAY area is the fully fenced backyard and LPA observed that it is free from defects or dangerous conditions. During today's inspection, there are no play structures which are required to be anchored. There are ample age-appropriate toys that appear to be safe and in good condition.

At 12:00 PM, LPA requested and reviewed the files of two (2) children in care and staff files. All children’s files contain Identification & Emergency Information, Parent's Rights, and Medical Consent forms and the staff file are found to be complete. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 02/29/2024. The licensee's Health and Safety training is completed, and CPR and First Aid certificate is current and expires on 04/14/2026. The licensee has completed mandated reporter training on 04/17/2024. The licensee is in ratio today. 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.

Effective August 1, 2003, California Law requires Family Child Care Home 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 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.



Per licensee does not administer medication at this time.

See 809-C
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
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: 07/01/2024
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Per licensee does not provide care for children under 2 years of age.

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.

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.

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

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

There are no deficiencies cited today. 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, Teresa Fernandez.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
LIC809 (FAS) - (06/04)
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