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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419122
Report Date: 11/30/2023
Date Signed: 11/30/2023 11:31:02 AM

Document Has Been Signed on 11/30/2023 11:31 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:YOUNG, KATINAFACILITY NUMBER:
013419122
ADMINISTRATOR:YOUNG, KATINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 881-9841
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
11/30/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:Katina YoungTIME COMPLETED:
11:02 AM
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Licensing Program Analyst Sidney Cortez, met with licensee Katina Young for an Unannounced Annual Random Inspection.

Present for this visit was the licensee Katina Richardson, her fingerprint cleared assistant Undrea Williams, and 1 infant and 2 pre school age children (3 total). The home was toured to conduct a Health and Safety Inspection.

The facility currently operates from 6:30AM until 6PM, MONDAY-FRIDAY.The facility is a one (1) story, residential home. The facility consists of a multi-purpose/classroom, living room, family room and kitchen, bedrooms, bathrooms, garage, and a yard. Overall the facility appears clean and in good repair. There are adequate and age appropriate toys, furniture and equipment. The home has a working smoke detector, carbon monoxide detector, working telephone, and First Aid Kit.

"ON LIMIT": Multi-purpose room, classroom (located outside of kitchen area), Living Room, Bedroom, which includes a sleeping area and activity room. Restroom: toilet and faucets are in working order. Part of the Kitchen and dining area: There are no accessible sharp items, cleaning solutions, or other hazardous items. Outdoor play area (not currently used due to weather).

Off limits area: Master bedroom, the room located in between the master bedroom, and the master restroom. The Isolation Area will be the bedroom that is on limit.

There is a covered and properly locked jacuzzi on the off limit area of the backyard. Per licensee, there are no firearms in the home. The home has a fully charged (3A40BC) fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The licensee CPR and First Aid certificate is current and expires (Oct , 2024).

The licensee's mandated reporter training is current and will expire in Jan 2024. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on
Nov 2023. 2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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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