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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423157
Report Date: 06/06/2024
Date Signed: 06/06/2024 01:39:08 PM

Document Has Been Signed on 06/06/2024 01:39 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:JONES, KIMBERLYFACILITY NUMBER:
013423157
ADMINISTRATOR/
DIRECTOR:		JONES, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 706-3376
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
06/06/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:08 PM
MET WITH:Kimberly JonesTIME VISIT/
INSPECTION COMPLETED:
03:07 PM
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Licensing Program Analyst Sidney Cortez, met with licensee Kimberly Jones for an Unannounced Annual Random Inspection. Present for this visit was the licensee Kimberly Jones,her fingerprint cleared staff Briana Williams and 1 infant, and 2 pre school age children (3 total children present).. The home was toured to conduct a Health and Safety Inspection.

The facility currently operates from 6:00AM until 6 PM, Monday-Friday. The facility has 3 bedrooms. 2 baths, living room, dining room, garage and backyard. The Off Limit areas are the bedrooms, and master bath, kitchen and garage. The doors to the bedrooms shall remain closed and locked while children are in care.The On Limit Areas are: the living room, dining room and hall bathroom and the backyard


Isolation area will be a portion of the living room area.There are ample age appropriate toys that are safe and appear to be clean. All hazardous materials and toxins are kept out of the reach of children.


The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone.Licensee also has a current CPR and First Aid certificate which is valid until June 2026. The licensee is in compliance with new immunization laws which pertain to day care providers. Per licensee there is no firearms in the home. The licensee's mandated reporter training is current and expires Feb, 2025. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted in April 2024.
2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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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