<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422888
Report Date: 02/21/2025
Date Signed: 02/21/2025 10:45:54 AM

Document Has Been Signed on 02/21/2025 10:45 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:PETERSON, KRISTINAFACILITY NUMBER:
013422888
ADMINISTRATOR/
DIRECTOR:		PETERSON, KRISTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 921-7885
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
02/21/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Kristina PetersonTIME VISIT/
INSPECTION COMPLETED:
11:00 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 February 21, 2025, at 8:00 AM, Licensing Program Analyst (LPA) Elimika Woods met with licensee Kristina Peterson for an Unannounced Annual/Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection was the licensee's fingerprint cleared assistant, eight (8) preschool age children and one infant child. The licensee is in ratio today. Licensee stated that the facility operates from Monday to Friday 7:00 AM to 5:30 PM.

LPA toured the facility inside and out to conduct a Health and Safety inspection. This single-story home consists of four bedrooms, two baths, a living and family room, kitchen, backyard, laundry room, and two car attached garage. This home was clean and orderly, with (centralized) heating and ventilation for the safety and comfort.

The off-limits will be made inaccessible by closed and/or locked doors and visual supervision. During the inspection, LPA checked the cabinets in the on limit areas which includes the living room, family room, kitchen, second bedroom at the end of hallway to the right, First bedroom on left side of hallway, bathroom on right side of hallway, laundry room, and any other cabinets or drawers accessible to children in care and did not observe any hazardous materials during today’s inspection. At 8:30 AM, LPA inspected the backyard area to make sure that there are no pools, hot tubs or any other bodies of water present that violates the childcare licensing laws and there were none, during today's inspection.

On-limit-areas include: Living room, family room, kitchen, second bedroom at the end of hallway to the right, First bedroom on left side of hallway, bathroom on right side of hallway, laundry room, and backyard

Off-limit-areas include: First bedroom on right side of hallway, bedroom (2) at the end of hallway, Attic, and Garage

Isolation area of the home will be a section of the living room, away from other children in care.

LPA tested the dual smoke and carbon monoxide detector in the hallway and found it to be functioning properly. This home has a fireplace that has a barricade/screen between the family and living room to prevent access by children. The licensee showed me her first aid kit that she keeps on a shelf next to the kitchen, and a fully charged 2A10BC fire extinguisher which meets standards established by the State Fire Marshal hanging next to that same shelf. LPA asked the licensee does she transports children and the licensee stated that she does not transport children.

See 809-C for continuance.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: PETERSON, KRISTINA
FACILITY NUMBER: 013422888
VISIT DATE: 02/21/2025
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
26
27
28
29
30
31
32
Per licensee, there are firearms in the home and the LPA verified that the firearms and ammunition are stored in an off-limits area of the home. During the record review LPA Woods checked the Health Records of the licensee, staff, and children and found that the licensee is following the immunization laws which pertain to all childcare providers. All required forms are posted and visible for public review.

The Backyard area is the fully fenced backyard and LPA observed that it is free from defects or dangerous conditions. During today's inspection, there are no play structures which are required to be anchored. The backyard has multiple small play structures with slides that has cushioning underneath to absorb children falls. There are ample age-appropriate toys that appear to be safe and in good condition and plenty of trees that provide shade to children while at play.

At 8:15 AM, LPA requested and reviewed the files of three (3) children in care and one (1) staff file. All children’s files contain Identification & Emergency Information, Parent's Rights, Immunization Records, and Medical Consent forms and the staff file has the required Employee Rights and Health Screening forms. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 10/17/2024. The licensee and her assistants Health and Safety training is completed, and CPR and First Aid certificate is current and expires 03/2025. The licensee has completed mandated reporter training on 03/30/23 and her assistant has completed hers on 02/25/23.

LPA's Observation during the visit:

Around 8:45 AM the licensee's assistant had the children in a small circle reading them a book and talking to them about the story. The children also marched around the playroom with their small instruments talking to one another and myself. Some of the children were curious on why I was here so I explained to them that I was here to make sure that they were in a safe environment. As more children began arriving to the day-care the licensee took a group of children and began to teach a lesson on the rug.

Effective August 1, 2003, California Law requires Family Child Care Home licensees 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 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The 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.

See 809-C for continuance.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: PETERSON, KRISTINA
FACILITY NUMBER: 013422888
VISIT DATE: 02/21/2025
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
26
27
28
29
30
31
32
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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: https://www.ada.gov/resources/child-care-centers/.

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-andresources/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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

The licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Kristina Peterson, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There are 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 Kristina Peterson.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC809 (FAS) - (06/04)
Page: 3 of 3