073402173-12-19-2023-02-CC-ILOA-CYP2XN-20231219164725

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073402173
Report Date: 12/19/2023
Date Signed: 12/19/2023 04:47:35 PM

Document Has Been Signed on 12/19/2023 04:47 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:	SIMS-CARR, KISA		FACILITY NUMBER:	073402173
ADMINISTRATOR:	SIMS-CARR, KISA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 222-2266
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94806
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	12/19/2023
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Kisa Sims-Carr		TIME COMPLETED:	04:57 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	On December 19, 2023 at 2:20pm Licensing Program Analyst (LPA) Indira Loza met with Licensee Kisa Sims-Carr to continue the Triennial inspection. Living in the home are the Licensee, her husband, her adult daughter, and 2 small dogs. Present during the inspection were the Licensee, her adult daughter, two infants, two preschoolers, and 4 school-age children. LPA conducted a tour for a health and safety check. The Licensee's operation hours are 6:30am-5pm. The house is a single family home consisting of 3 bedrooms, two bathrooms, kitchen, living room, dining area, den, garage, and fully fenced in backyard. On Limit Areas - The living room, den, kitchen, dining area, bathroom in the hallway, and patio in the backyard. Off Limit Areas - All three bedrooms, master bathroom, and garage. Licensee is reminded that all off limit areas are kept inaccessible through locked/closed doors, baby gates, and visual supervision. Isolation Area - is in the living room The home has a fully charged 3A40BC fire extinguisher, a working combined carbon monoxide and smoke detector in the hallway, and a working telephone. The Licensee stated she has Liability Insurance which expires September 1, 2024. The Licensee had a current Mandated Reporter Certificate which expires on February 1, 2025. The Licensee has a current CPR certificate which expires January 30, 2025. The home has heating and ventilation for safety and comfort, the daycare areas are spacious and free of clutter. The Licensee has ample age-appropriate toys and learning materials in the home and in the backyard. Toxins, medicines, and hazardous items were inaccessible during today's inspection, all cabinets had a child proof lock preventing access by the children. There were no bodies of water present on the premises. Per the Licensee there are no firearms in the home. The fire/disaster log was current and the last fire drill was conducted on November 21, 2023. LPA observed infants napping in their play pens, there were no blankets or pillows. The sheets were fitted on the cribs mattress with no wrinkles and the infants were not using a ********************************Report Continues on LIC 809-C*****************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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: SIMS-CARR, KISA	FACILITY NUMBER: 073402173
	VISIT DATE: 12/19/2023

NARRATIVE

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pacifier.

LPA reviewed five children files and found that the Licensee was not logging in each 15 minute check during naps which is a Type B violation. LPA provided the Licensee with the Infant Safe Sleep Regulations and a sleep log template. During the facility file review, LPA found that the Roster was not being maintained, which was a Type B violation. There was a Type A violation issued for Criminal Record Clearance. These citations were issued on December 13, 2023 during the initial visit. Since then, the Licensee has cleared the citation for the Roster by emailing the LPA a copy of an updated roster. There was also one Type A citation issued for an adult, Shakyna Russell, working in the facility without a cleared background check. The uncleared adult was not in the facility during today's visit.

Incidental Medical Services (IMS) policy was discussed. The Licensee is currently not providing IMS to the children in care. For IMS information see PIN 22-02. When any IMS is 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, 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 onFamily 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.

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.
**********************************Report Continues on LIC809-C********************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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: SIMS-CARR, KISA	FACILITY NUMBER: 073402173
	VISIT DATE: 12/19/2023

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During the Exit Interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There was one Type A and Two Type B citations issued during this inspection.

Exit interview conducted and report was reviewed with Licensee Kisa Sims-Carr.
Report and Appeal Rights were provided.
A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC809 (FAS) - (06/04)

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