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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409259
Report Date: 03/27/2023
Date Signed: 03/27/2023 11:29:48 AM

Document Has Been Signed on 03/27/2023 11:29 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:VINCENT, JACQUELINEFACILITY NUMBER:
073409259
ADMINISTRATOR:VINCENT, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 237-3332
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Jacqueline VincentTIME COMPLETED:
11:45 AM
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On 03/27/2023 at 8:50 AM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced annual inspection for Jacqueline Vincent large family child care home. LPA met with licensee and guided analyst on a tour of the facility. During today's inspection, there were no children in care and 14 children enrolled. Family members residing in the home are licensee, licensee adult daughter and licensee's 4 grandchildren. Licensee and all adults in the home have criminal record clearance. Facility hours of operations are Monday - Friday from 9:00 AM - 11:30 PM.

This is a two story home which consists of 4 bedrooms, 2 1/2 bathrooms, sitting room (entry way) kitchen, dining room, family room, attached garage, backyard with a chicken coop on the left side of backyard that is gated off and locked shed.
The children on limits areas: Family room, sitting room (entry way), dining room, downstairs half bathroom,
Areas off limits include: 3 upstairs bedrooms, 2 bedroom, office/bedroom on the first floor, kitchen, attached garage, locked shed in backyard,
The LPA toured all areas used by children during this visit.

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 are stairs in the home that are made inaccessible for children in care. There is a working telephone in the home. Detergents, poisons, cleaning compounds, medications, and other items which can pose a danger to children are made inaccessible in the home. Per licensee, there are no weapons or firearms in the home. Licensee has an up to code 2A10BC fire extinguisher and working smoke/carbon monoxide detector on the premises. Licensee last conducted fire drill 02/08/2023. Licensee stated they have 2 turtle, 2 dogs and 2 hens in the facility. *CON'T ON PAGE 2*
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2023
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 3
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: VINCENT, JACQUELINE
FACILITY NUMBER: 073409259
VISIT DATE: 03/27/2023
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*PAGE 2*

LPA inspected the backyard and observed a fenced backyard safe for children. LPA also observed age appropriate toys for children to play with. Licensee stated during the summer, she take children out of the facility for field trips. LPA reminded licensee when outside of the facility, 100% supervision of children in care is required. LPA did not observed any bodies of water. Facility provide transportation for children, but understands that children cannot be left alone, unattended in parked vehicles

Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The licensee Pediatric First Aid and CPR certificate will expire in 02/2024. Licensee stated she was unaware of infant safe sleep log. LPA reminded licensee of the importance and the requirement of maintaining sleep log for infant children in care. Licensee stated they will start logging and maintaining sleep log for infants. Required postings were observed near the entrance.

LPA reminded licensee day care needs to be operated within the limitations and capacity of a Large Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.


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.

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.

*CON'T ON PAGE 3*

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

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: VINCENT, JACQUELINE
FACILITY NUMBER: 073409259
VISIT DATE: 03/27/2023
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*PAGE 3*

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 has provided Mandated Reporter certificate and the certificate will expire 01/2024.

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.

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

In the areas that were evaluated, there were no violation observed.

Exit interview conducted and report was reviewed with the licensee, Jacqueline Vincent. 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: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
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