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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422872
Report Date: 01/18/2023
Date Signed: 01/18/2023 12:32:36 PM

Document Has Been Signed on 01/18/2023 12:32 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MONTGOMERY-SIMMONS, HORTENSEFACILITY NUMBER:
013422872
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
01/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Hortense Montgomery-SimmonsTIME COMPLETED:
12:30 PM
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An unannounced Required - 1 Year inspection was conducted by Licensing Program Analyst L. Dyer. LPA arrived at the facility at 9:37 a.m. The licensee was present with 1 day care child (preschool-age). Facility is in compliance with licensed capacity and facility ratios. Phone number and e-mail address are current. Hours: 7:30 a.m. - 5:30 p.m.
At 9:57 a.m., the following was observed: the day care area of the home was inspected. Areas licensed for child care: bathroom, living room, back bedroom. Licensee has requested that the game room be added to the day care area. THIS IS A CHANGE IN THE LICENSED AREA OF THE HOME. Licensee was instructed to provide a new facility sketch within 7 days. 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. There was a working smoke detector (tested); a fully charged 2-A:10-B:C fire extinguisher; a first aid kit, and a carbon monoxide detector. Licensee stated there were no firearms or bodies of water on the premises. No fireplace. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Children play in the back yard and the front yard. Both areas are securely fenced. Licensee has slides, riding toys, swings, teeter-totter, child sized kitchen sets, etc. for child play. Licensee has padding/cushioning under the slides. Children have not played outside recently due to rainy weather.
Licensee currently has no infants in care, but 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. 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. (continued)
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2023
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MONTGOMERY-SIMMONS, HORTENSE
FACILITY NUMBER: 013422872
VISIT DATE: 01/18/2023
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Also given and discussed: Guidance for Child Care Providers and Programs (version June 29, 2021) and Individual Sleeping Plans. Sleep plans were reviewed for children who are now over age 2. LPA reviewed personnel, facility, and children's records at 1:17 p.m. Licensee's Mandated Reporter Training expires 11/25/2024. Licensees' CPR/First Aid expires May, 2023. Last disaster drill completed November 2022. Facility roster was current. Required postings are visible for public review. LPA reviewed facility, children's and personnel records at 10:11 a.m. Facility roster was obtained.
All adults present during this inspection were fingerprint cleared and associated to the facility. 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; advertisements; construction work at facility; paying fees on-line; smoking; large family child care home; ill children in home, and the Guardian background check process.
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. For updates, click the "Receive Important Updates" box.
Mandated Reporter Training:www.mandatedreporterca.com (Child Care Providers Module - required every 2 years).
Alameda County Public Health Department Website: www.acphd.org
Guardian: background check process with self-service options: https://www.cdss.ca.gov/inforesources/ cdss-programs/community-care-licensing/caregiver-background-check/guardian
(cont)
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023
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: MONTGOMERY-SIMMONS, HORTENSE
FACILITY NUMBER: 013422872
VISIT DATE: 01/18/2023
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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 Hortense Montgomery-Simmons.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023
LIC809 (FAS) - (06/04)
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