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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423302
Report Date: 08/16/2022
Date Signed: 08/16/2022 12:29:14 PM

Document Has Been Signed on 08/16/2022 12:29 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:LELENOA, LAMONAFACILITY NUMBER:
013423302
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
08/16/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Lamona LelenoaTIME COMPLETED:
12:50 PM
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On 8/16/2022, Licensing Program Analysts (LPAs), Melissa Guirit and Melissa Domantay conducted an in-person case management/increase in capacity inspection. Present during today's inspection were the licensee, four preschool aged children, and finger print cleared husband and daughter. The on limit areas of home was toured to conduct a health and safety inspection with the licensee. Hours of operation for day care are Monday through Friday 7:00am to 6:00pm.

Community Care Licensing (CCL) has received an approved fire clearance on 03/2/2022 by the Oakland Fire Department.

The home is a 2 story house which is neat and clean with heating and ventilation for the safety and comfort of the children. The first story consists of the living room, dining room, kitchen, bathroom, and back family room and eat in area. The second story consists of four bedrooms and a bathroom. The off limit areas include the garage and second story of the home.

The on limits areas are the family room and backyard. Both areas were inspected by LPAs to conduct a health and safety inspection. The off limits area are include the garage and second story of the home. Off limit areas will be made inaccessible by use of gates, closed and/or locked doors and visual supervision. There are age appropriate toys in the home. The isolation will be in the living room on the couch. Per licensee, there are no firearms in the home. LPAs did not observe any hazardous materials or toxins accessible to children during today's inspection. The home has a fully charged 2A10BC fire extinguisher, working smoke detector and carbon monoxide, telephone, and fully stocked first aid kit.

See 809-C for continuance.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2022
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: LELENOA, LAMONA
FACILITY NUMBER: 013423302
VISIT DATE: 08/16/2022
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The Licensee's CPR and First Aid certificate is current and expires 08/12/2024. Licensee's Mandated Reporter training certificate is current and expires 3/7/2024. Preventative Health and Safety training with Lead poisoning training was completed by Licensee. Licensee is in compliance with immunization requirements.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

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.

No deficiencies observed at this visit. The licensee is now approved for an increase in capacity to operate as a large family day care home.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Lamona Lelenoa

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC809 (FAS) - (06/04)
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