013423936-3-14-2024-02-CC-BGOY-D3CPW5-20240314114011

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423936
Report Date: 03/14/2024
Date Signed: 03/14/2024 11:40:27 AM

Document Has Been Signed on 03/14/2024 11:40 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	FABIAN, LAURA		FACILITY NUMBER:	013423936
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/14/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Laura Fabian		TIME COMPLETED:	12:00 PM

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On 3/14/24, Licensing Program Analysts (LPAs) Brindha Govindasamy and Diana Campos conducted an announced Change of location inspection and met with licensee Fabian Laura. Applicant was perviously licensed at a different location. LPAs disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Residing in the home and present during inspection are Licensee, Spouse, her 2 adult children and licensee's mom. Licensee has 2 small dogs. The facility was toured to conduct a health and safety inspection. Licensee plans to operate Monday through Friday from 7AM to 5:30PM.

This home is a single story house consisting of three bedrooms, two bathrooms, laundry room, a living room, dining room and kitchen. There is a large fully fenced front yard and fully fenced backyard. The home was observed to be neat and clean with heating and ventilation for safety and comfort of the children.

On-limit-areas are: Entrance hallway leading to living room, closet, dining room, hallway bathroom, Bedroom 1, and Bedroom 2.

Off-limit-areas are: Kitchen, Laundry room, Master Bedroom and Bathroom which are made inaccessible to children today by use of child proof gate, latches, child proof doorknobs, closed or locked doors and visual supervision at all times. Licensee was reminded to inform licensing office so that and inspection can be completed prior making any changes to off/on limit areas.

Outdoor play area

On-Limit areas are : Front and left side yard.

Off-Limit areas are : Garage, Gated stairs leading to laundry room, Entire backyard with a small basement and right side of yard leading to backyard (gated). Continue page 2

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: FABIAN, LAURA	FACILITY NUMBER: 013423936
	VISIT DATE: 03/14/2024

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Isolation area: Bedroom 1

There are age-appropriate toys which are observed to be safe, clean and in good repair. Licensee plans on providing Lunch and two snacks to the children. There are no bodies of water or pools accessible to children in care during today’s inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. There is a fireplace in the living room that is blocked to prevent children access. Licensee states there are no firearms in the home. Licensee will not be providing Overnight Care. Off limits areas are made inaccessible by closed and/or locked doors, gates, and visual supervision.

The home has a fully charged 3A 40 BC fire extinguisher in the kitchen, a working smoke detector, a plug-in carbon monoxide detector and a working telephone. Licensee’s CPR/ First aid certificate expires on 8/2024 and the Mandated Reporter Certificate expires on 12/19/25.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

APPLICANT OWNS THE HOME: Applicant provided proof of control of property.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (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. Cont page 3

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: FABIAN, LAURA	FACILITY NUMBER: 013423936
	VISIT DATE: 03/14/2024

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LPA reviewed with licensee the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page athttps://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.

On 1/30/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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

Website links for provider resources:

Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov.
Guardian Background Check: www.guardian.dss.ca.gov

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The family home is recommended for Small Family Childcare Home license effective 3/14/24. Exit interview conducted and report was reviewed with the Licensee Laura Fabian.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC809 (FAS) - (06/04)

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