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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421970
Report Date: 05/16/2023
Date Signed: 05/16/2023 02:56:38 PM

Document Has Been Signed on 05/16/2023 02:56 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:HENDRICKS, LISAFACILITY NUMBER:
013421970
ADMINISTRATOR:HENDRICKS, LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 339-4121
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
05/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:licensee, Lisa HendricksTIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee, Lisa Hendricks for an unannounced Annual Random Inspection. Present for the inspection were licensee and fingerprint cleared and associated wife (assistant) Sally Scrutchin, supervising, 3 infants, 4 preschoolers and 2 school age children.The home is a single-story home with 3 bedrooms, 2 bathrooms, living room, kitchen, dining room, garage, and back yard. The hours of operation are 7:00am to 6:00pm, Monday -Friday.

on limit area are the living room and dining room, the kitchen, hallway bathroom, and all three bedrooms that will be used for nap time only.

Off-limit-areas are the master bathroom and the garage. All off limit areas are inaccessible by closed and/or locked doors and visual supervision.

LPA inspected the house for health and safety hazards. Daycare Area is equipped with age-appropriate toys and equipment for children. Home has a working telephone, a working smoke and carbon monoxide detector, and a fire extinguisher that meets the minimum requirements. There are child size tables and chairs for snack and activities. The napping cots in good condition and each child have their separate blankets. Licensee states there are no guns or weapons of any kind in the home. There are three (3) animals at the facility. One (1) bearded dragon, and two (2) Guinea Pigs in the dining area. The bearded dragon is housed in locked terrariums and Guinea pigs are housed in locked cage. There are monkey bars that is not used for day care children, and it fenced off to prevent access to daycare children. There is swing set in the backyard properly anchored. Per licensee it is only for the school age children. The fireplace in the day care is barricaded. Licensee’s CPR is current. Licensee provides daily snacks and meals. Discipline policy is redirection. LPA reviewed children’s files. All the files are complete and up to date. All required postings are properly posted. LPA discussed safe sleep guidelines and reminded to document 15 minutes sleep check.


see next page..
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023
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: HENDRICKS, LISA
FACILITY NUMBER: 013421970
VISIT DATE: 05/16/2023
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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

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.

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

Exit interview conducted and report was reviewed with the licensee, Lisa Hendricks.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
LIC809 (FAS) - (06/04)
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