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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423656
Report Date: 02/03/2022
Date Signed: 02/03/2022 12:25:37 PM

Document Has Been Signed on 02/03/2022 12:25 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:BERNSTINE, LYNESHAFACILITY NUMBER:
013423656
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
02/03/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lynesha BernstineTIME COMPLETED:
12:35 PM
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
Licensing Program Analyst Lisa Dyer conducted an announced pre-licensing inspection due to a location change. Present were the applicant and 1 minor child. The home was toured and consists of 3 bedrooms, 1 bathroom, living room, dining room, nook, and kitchen. Applicant will be utilizing the living room, dining room, kitchen, nook and the bathroom for the day care area. Off limits areas are 3 bedrooms. These areas will be inaccessible by closed and/or locked doors; door knob covers; gates and visual supervision.

At 10:25 a.m. the following was observed: Isolation area for sick children will be in the living room. There are no toxins accessible today. There is a blocked wall heater. There is a 2-A:10-B:C fully charged fire extinguisher, a working smoke detector (tested), carbon monoxide detector and a first aid kit. There are toys and play space available. Children will sleep on mats and play yards. Per applicant, there are no firearms or bodies of water on the premises. Non-functioning fireplace in the living room is blocked and screened. Applicant has a cell phone. Backyard is currently not safe for child play and will not be licensed. Children will play in the front of the home and down the driveway. No pets. There are 3 fingerprint cleared adults that live in the home.

Training: Applicant has completed Preventative Health Training; CPR/First Aid Training; and Mandated Reporter Training. The applicant is renting the property, and verification was viewed.

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.

Licensing forms were provided and reviewed to maintain facility and children's files; and to post in (continued)
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2022
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 2
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: BERNSTINE, LYNESHA
FACILITY NUMBER: 013423656
VISIT DATE: 02/03/2022
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
public area. Applicant was instructed to conduct and document periodic fire and disaster drills. Discipline methods were discussed. Applicant was instructed that spanking is not allowed. Proposed hours of operation: 7:00 am - 5:30 pm. The handout, "A Child Care Provider's Guide to Safe Sleep" was provided and discussed, along with Individual Infant Sleeping Plan requirements. Applicant was informed that baby bouncers, johnny jumpers, and saucer chairs were not allowed in the home; and that all persons 18 years of age or older who frequently visit, work or reside in the home shall be fingerprint cleared prior to being in the presence of day care children. Also discussed: children in parked vehicles; substitutes; training videos; changes to the facility; fingerprinting/association; advertisements; on-limit areas, large family child care homes, smoking and Zero Tolerance Regulations. Applicant was reminded that Mandated Child Abuse Training, as well as First Aid/CPR training is required to be completed every 2 years.

Applicant was given Title 22 regulations, and reminded that licensing updates and forms can be located on our website: www.ccld.ca.gov. For CCL Updates, go to www.ccld.ca.gov. Click the "Receive Important Updates" box. Enter your e-mail address for the Child Care Advocate Program.

Websites: Community Care Licensing: https://www.cdss.ca.gov
Mandated Reporter Training - www.mandatedreporterca.com. (Child Care Providers Module).
Alameda County Public Health Department Website: www.acphd.org
Guardian Background Check: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

The applicant was requested to complete the following item(s) prior to the issuance of a license:
1. Place door knob covers on bedroom.
2. Gate area to block off laundry room from kitchen.
3. Block wall heater on the dining room side.

Applicant states that items will be completed within 10 calendar days. (Additional information may be requested.)

Exit interview conducted. Applicant was given appeal rights.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2