013419340-4-29-2022-52-CC-KPHN-CDXPQ3-20220429113029

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419340
Report Date: 04/29/2022
Date Signed: 04/29/2022 11:30:41 AM

Document Has Been Signed on 04/29/2022 11:30 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	PENNYWELL, HELANA		FACILITY NUMBER:	013419340
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 6	CENSUS: 3	DATE:	04/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Helana Pennywell		TIME COMPLETED:	11:40 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 04/29/2022 approximately at 8:45AM Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced required inspection, and met with Licensee Helana Pennywell. Present for this inspection was two preschool aged children along with a school aged child. Also residing in the home is the licensee's fingerprinted and associated adult son. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 5:00am to 5:00pm. ON LIMITS: hallway bathroom, dining/living room, and fenced front yard; isolation area is dining room OFF LIMITS: kitchen, bedroom #1, bedroom #2. Off limit areas are inaccessible by closed and/or locked doors, gates, and visual supervision. The home is apartment, which is neat and clean, with heating and ventilation for safety and comfort. A child safety gate is being used at the kitchen as the Licensee is using a gate to keep children in the living/dining room area. There were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. There was a fully charged 2A10BC fire extinguisher, dual carbon monoxide and smoke detector, and working telephone. At 9:50AM, LPA was informed that some children do bring their own lunches; LPA observed that one child's lunch was not properly labeled with dates to prevent cross contamination. Licensee states that the child's parent may have forgotten but usually will keep it separated from other children's foods and will remind parents to have it labeled. At 10:00AM, LPA toured the ON limit areas and was informed by licensee that her wall fire heater is not screened, however it is not operating during day care hours, and has a child safety gate to ensure it is inaccessible to children. Licensee states since wall heater is not screened, she does escort children to the bathroom or has a potty chair in the ON limit area. Per licensee, there are no firearms in the home. At 10:10AM, LPA observed a small tank that has a turtle in the living/dining area. Licensee states she is always with the children and children does not play around the area where the small tank is located; LPA suggests licensee to keep full visual supervision while children are playing to prevent any incidents. Licensee understood and states children would ask or points to any toys nearby and she would grab it for them. SEE LIC 809 C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PENNYWELL, HELANA	FACILITY NUMBER: 013419340
	VISIT DATE: 04/29/2022

NARRATIVE

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At 10:30am, 6 children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. Licensee has proof of the required immunization. The licensee have required mandated reporter training that is completed as of 02/28/2022. CPR and First Aid training are also updated as of 06/12/2023. The licensee conducts and documents fire drill log indicates a drill was conducted 04/01/22. All required licensing documents are posted and visible for public review.

There were no deficiencies were cited for today's inspection

Appeal rights and a notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Exit interview conducted and report was reviewed with licensee Helana Pennywell

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 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.

SEE LIC 809 C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PENNYWELL, HELANA	FACILITY NUMBER: 013419340
	VISIT DATE: 04/29/2022

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Incidental Medical Services (IMS) policy was discussed. This facility does not provides IMS to children in care.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 was reminded that California Law requires licensed Child Care Centers 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. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. 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.

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.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

LIC809 (FAS) - (06/04)

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