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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421685
Report Date: 02/17/2023
Date Signed: 02/17/2023 11:40:17 AM

Document Has Been Signed on 02/17/2023 11:40 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CUSSEAUX-VITAL, DENISEFACILITY NUMBER:
013421685
ADMINISTRATOR:CUSSEAUX-VITAL, DENISEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 568-8899
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
02/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:34 AM
MET WITH:Denise Cusseaux-VitalTIME COMPLETED:
11:30 AM
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An unannounced Required - 1 Year inspection was conducted by Licensing Program Analyst Lisa Dyer. LPA arrived at the facility at 7:34 a.m. Present at the facility: the licensee, her fingerprint cleared husband, and 4 day care children (1 infant and 3 preschool-age). Facility is in compliance with licensed capacity and facility ratios. Phone number and e-mail address are current. Hours: 6:30 a.m. - 5:30 p.m.
At 7:54 a.m., the day care area of the home was inspected. Areas licensed for child care: living room, dining room, playroom, den and bathroom. This is a change in the on-limit area of the home. Off-limit areas will be made inaccessible to children by closed and/or locked doors; gates; and visual supervision.
The home was clean and orderly, with adequate heating and ventilation. There were safe, healthful and comfortable accommodations, furnishings and equipment available to children at the time of this inspection. There were a variety of books and toys for children's use. Facility has functioning cell phone, smoke/carbon monoxide detector combo and fire extinguisher (3A:40:BC). She has a first aid kit and a thermometer. Licensee stated there were no firearms or bodies of water on the premises. Fireplace was blocked by a cabinet. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Hazardous items are kept in a closet with a safety lock, inaccessible to children.
Back yard area is securely fenced. Licensee has riding toys, balls, slides, and other toys for outdoor play.
Licensee currently has 1 infant in care over 12 months of age, in which a sleeping plan is not required. LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and- resources/safe-sleep as an additional resource. Safe Sleep Handouts were also given to the licensee. 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.
Safe Sleep Reminders - Documentation must be maintained for each child under 24 months of age as they nap (15 minute increments). An Individual Sleeping Plan is needed for each infant up to 12 months of age. Infants must sleep on their backs. Infants breathing, skin color, and body temperature must be (continued)
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: CUSSEAUX-VITAL, DENISE
FACILITY NUMBER: 013421685
VISIT DATE: 02/17/2023
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monitored. Cribs or play yards must not hinder the entrance or exit to and from the sleeping space. Mattresses must be firm, sized appropriately, and be covered with a tightly fitted sheet, with no objects hanging above or attached. Sheets must be replaced when soiled or wet.
LPA reviewed personnel, facility, and children's records at 9:41 a.m. Licensees' CPR/First Aid expires 9/26/23. Last disaster drill completed on 2/17/23. Children's files are complete. All required forms are posted and visible for public review. Disaster drills are conducted and dates are being logged. Roster is current.
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 maximum per day/per person will be assessed if this regulation is violated. Licensee was also reminded of the Department's Inspection authority, and the need to comply when notified that termination of an employee is necessary.
Also discussed with the licensee: supervision of children at all times; children are not to be left in parked vehicles; car seats and high chairs; Unusual Incident Reporting; ill children in home; advertisements; construction work at facility; paying fees on-line; and smoking.
(A qualified assistant must be physically present whenever 9 or more children are in care. When an assistant is not present, the home reverts back to small family child care ratios)
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/inspection-process.

Important E-mail Addresses:
Community Care Licensing General Information and Updates:www.ccld.ca.gov.
Mandated Reporter Training:www.mandatedreporterca.com (Child Care Module - every 2 yrs).

NO DEFICIENCIES CITED TODAY.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Denise Cusseaux-Vital.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC809 (FAS) - (06/04)
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