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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423979
Report Date: 08/26/2024
Date Signed: 08/26/2024 01:46:39 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/26/2024 01:46 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:PHELON, JESSICAFACILITY NUMBER:
013423979
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
08/26/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Jessica PhelonTIME VISIT/
INSPECTION COMPLETED:
01:55 PM
NARRATIVE
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On 8/26/2024 at 8:35 AM Licensing Program Analyst (LPA) Janai McClain met with Licensee Jessica Phelon for an Unannounced Capacity Increase Inspection. Present during the inspection were one school age child, one preschool age child, and two infants in care. The Licensee’s home was toured for a health and safety inspection. The facility operates Monday-Friday 7:30 AM-5:30 PM.

LPA toured the home with the applicant to conduct a health and safety inspection. LPA observed that it is neat and clean with heating and ventilation for the safety and comfort of children. This one story apartment consists of a living room, kitchen, three bedrooms, three bathrooms, an office, and a patio.

The Off Limit Areas are the second and third bedroom, the second (2) bathroom, the third (3) bathroom, the office, and the kitchen. The off limit areas are made inaccessible by gates, closed and/or locked doors and visual supervision.

The On Limit Areas are the first bedroom on the left, living room, patio, and first (1) bathroom on the right.

Isolation Area - living room

Inside the home the LPA observed an ample supply of age appropriate toys, activities and equipment for children, which appeared to be safe and in good condition. LPA did not observe any medication, bodies of water, hazardous items or poisons accessible to children during the inspection today.

This home was granted a fire clearance on 8/7/24 from the Oakland Fire Department.

The applicant stated there are no firearms in the home. The home is equipped with a fully charged 2A10BC fire extinguisher, a working combination smoke and carbon monoxide detector, and a telephone. Applicant completed the 16-hour health preventative training which includes 8 hour pediatric CPR and first aid which expires 1/2025 and 8 hour Preventive Health & Safety Training which included one hour of Child Care Nutrition and Lead poison Prevention training. Applicant has completed the Mandated Reporter training on 3/21/2023. *******************************Report Continues on LIC 809-C*******************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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: PHELON, JESSICA
FACILITY NUMBER: 013423979
VISIT DATE: 08/26/2024
NARRATIVE
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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, 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.

Due to one Type B citation being issued during todays visit, the capacity increase will remain in pending status until all citations have been cleared.


Exit interview conducted and report was reviewed with the Licensee Jessica Phelon.

Appeal Rights provided.

Notice of Site Visit must remain posted for 30 days.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/26/2024 01:46 PM - It Cannot Be Edited


Created By: Janai McClain On 08/26/2024 at 01:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: PHELON, JESSICA
FACILITY NUMBER: 013423979

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/09/2024
Section Cited
CCR
102425(a)(3)

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102425(a)There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that... overlaps the underside of the mattress so it cannot be dislodged.
This requirement is not met as evidenced by:
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Licensee shall purchase sheets for the Pack n Plays and email the LPA a summary of what was learned in the Safe Sleep regulation provided to the Licensee by 09/09/2024.
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Based on observation, the licensee did not comply with the section cited above as two out of two Pack n Plays did not have sheets, which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Janai McClain
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2024


LIC809 (FAS) - (06/04)
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