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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419247
Report Date: 04/18/2023
Date Signed: 04/18/2023 11:15:23 AM

Document Has Been Signed on 04/18/2023 11:15 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:NELSON, GRACIEFACILITY NUMBER:
013419247
ADMINISTRATOR:NELSON, GRACIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 324-1060
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
04/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Gracie NelsonTIME COMPLETED:
12:00 PM
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Licensing Program Analyst Sidney Cortez and Licensing Program Manager Wynn Norona, met with licensee Gracie Nelson for an Unannounced Annual Random Inspection. Present for this visit was the licensee Gracie Nelson, and one infant. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 5:00AM until 6:00 PM, MONDAY-FRIDAY.The home is two story which consists of 4 bedrooms, 2 bathrooms, living room, dining area and kitchen : family room, day care room, play room, fenced backyard and garage

The home is clean with centralized heating and ventilation for safety and comfort. On Limit area: family room/daycare room, playroom, fenced backyard, and the bathroom on the 1st floor.

The Off limit areas are entire 2nd floor which is barricaded by a gate by the stairs during day care hours; which will be inaccessible by closed and/or locked doors and visual supervision at all times.

The Isolation Area will be the play room area. The fenced outdoor play area is free from defects or dangerous conditions. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children.

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 Health and Safety training is completed and CPR and First Aid certificates are current and expires in April, 2024. The licensee's mandated reporter training is current and expires (Aug, 2023). The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on
March 5, 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: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2023
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: NELSON, GRACIE
FACILITY NUMBER: 013419247
VISIT DATE: 04/18/2023
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During Inspection, 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 $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with licensee 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 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.

Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

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.

A notice of site visit was given and must remain posted for 30 days.

There are no deficiencies cited today.

Exit interview conducted and report was reviewed with the licensee, Gracie Nelson.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
LIC809 (FAS) - (06/04)
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