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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423302
Report Date: 03/09/2023
Date Signed: 03/09/2023 03:29:49 PM


Document Has Been Signed on 03/09/2023 03:29 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:LELENOA, LAMONAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 890-9620
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:14CENSUS: 0DATE:
03/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Lamona LelenoaTIME COMPLETED:
03:35 PM
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On 03/09/2023 at 2:15pm Licensing Program Analysts (LPA's) Michelle Sutton and Diana Campos conducted an unannounced Annual Required inspection at Lamona Lelenoa Family Childcare Home. LPA's met with licensee Lamona Lelenoa and explained the purpose of today's inspection. LPA's were granted the inspection authority to enter the Home. The family childcare home days and hours of operation are Monday to Friday 7:00am to 06:00pm. Present in the home at time of inspection were the licensee and minor daughter. No day care children were present during today's 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.

Indoor Space: At 2:30pm a health and safety tour of inside the home was done. LPA's toured the premises with licensee. The home is sanitized and orderly in compliance with Title 22 Regulations at this time. There is a 2A10BC fire extinguisher, working smoke and carbon monoxide detector in the home. The home is a three story home. The first story consists of the basement, which is used for storage, and backyard. The second story consists of the living room, dining room, kitchen, bathroom, and rear deck which has been converted into a family room and eat in area. The third story consists of four bedrooms and a bathroom. The off limit areas include the entire first and third story of the home. There is a gate for the stairs leading up to the third story, and the backyard and basement are only accessible from outside of the home, and is made inaccessible by a closed and/or locked door. The on limit areas include the entire second story of the home. The isolation area will be in the living room.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2023
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: LELENOA, LAMONA
FACILITY NUMBER: 013423302
VISIT DATE: 03/09/2023
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No children files were reviewed during today's inspection. Facility files were reviewed. Facility contained Children's Roster, Licensee’s mandated reporter training expires 3/7/2024, pediatric CPR and first aid expires 8/12/2024 .

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

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 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 Lamona Lelenoa.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
LIC809 (FAS) - (06/04)
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