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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409035
Report Date: 06/17/2022
Date Signed: 06/17/2022 01:24:30 PM

Document Has Been Signed on 06/17/2022 01:24 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:PULVER, DIANNAFACILITY NUMBER:
073409035
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
06/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Dianna PulverTIME COMPLETED:
01:30 PM
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On 06/17/22 at 11:30 AM Licensing Program Analyst (LPA), Christina Watts conducted an unannounced annual inspection at Dianna Pulver's family day care and met with Licensee, Dianna. LPA explained the purpose of today's inspection. Licensee currently is licensed as a Small Family Child Care Home with a capacity of eight (8). During today's inspection, there were no children in care due to facility currently is closed due to 2 positive cases of COVID-19. Facility closed day care starting from today, Friday, June 17, 2022. Licensee states she has contact licensing to report 2 COVID cases. Facility will reopen on Wednesday June 22, 2022. Days and hours of operation will be Monday through Friday from 6:30 AM - 6:00 PM. She will be caring for only school age children with 1 infant whose parent works in the facility. Licensee applied for a change of capacity from a small family home to a large family house. That application has been approved effective 06/17/2022.
There are total of seven adults and two children residing in the home: Licensee, her spouse, licensee 3 adult children and licensee 2 grandchildren ages 8 and 7, as well as a friend of licensee who are all fingerprint cleared. Licensee will be completed her Pediatric CPR/First Aid and Mandated Reporter. Licensee has documentation maintained for Measles, Pertussis Immunization's, Influenza Opt-Out statement for the current flu season. Licensee understands that when care for more than six and up to eight is provided, she must notify parents. There is a working telephone in the home. Fire clearance request was approved 05/18/2022 by ECC Fire Protection Department.
INDOOR SPACE: LPAs inspected the indoor space of the home. The home is two stories consisting of 3 bedrooms, 2.5 bathrooms, kitchen, dining area, living room, upstairs loft, attached garage and detached The home is sanitary, safe and orderly, with heating and ventilation for safety and comfort.
IN-USE AREAS: Living room, downstairs bathroom, half bathroom, and large yard that included treehouse, a pool, and a deck.
OFF LIMIT AREAS: Entire second floor which contains 1 bedroom, 1 bathroom and upstairs loft, attached garage, detach garage.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2022
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: PULVER, DIANNA
FACILITY NUMBER: 073409035
VISIT DATE: 06/17/2022
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Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating system for safety and comfort. There were safe toys, play equipment and materials observed for children. There is a working telephone in the home. Detergents, poisons, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible in some areas of the home. There are currently no pets in the house.

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. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The licensees have current Pediatric First Aid and CPR certificate which will expire 05/2024. Required postings were observed near the entrance.

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) Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

On or before March 30, 2018 any person who works in a child care facility shall complete Mandated Reporter training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

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.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
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: PULVER, DIANNA
FACILITY NUMBER: 073409035
VISIT DATE: 06/17/2022
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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/process.

At this time, there are no citations being issued today.

Exit interview conducted at 1:15 PM and report was reviewed with the licensee, Dianna Pulver. A notice of site visit was given and must remain posted for 30 consecutive days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
LIC809 (FAS) - (06/04)
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