073409385-3-15-2023-02-CC-THAR-CPXQWF-20230315123152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409385
Report Date: 03/15/2023
Date Signed: 03/15/2023 12:32:09 PM

Document Has Been Signed on 03/15/2023 12:32 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:	JOHNSON, YUKA		FACILITY NUMBER:	073409385
ADMINISTRATOR:	JOHNSON, YUKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 457-7223
CITY:	MARTINEZ	STATE: CA	ZIP CODE:	94553
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	03/15/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	YUKA JOHNSON		TIME COMPLETED:	12:45 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	8:00AM Licensing Program Analyst Alexander met today with Yuka Johnson for an ANNOUNCED PRE-LICENSING INSPECTION. Applicant is the only one present for the inspection. The home is a tri-level house consisting of 4 bedrooms, 3 bathrooms, living room, eat-in kitchen, laundry area, family room and garage. The primary areas for day care will be the backyard and the first level of the home which includes the family room and a 1.5 bathroom. Children will have to walk through the laundry area to use the bathroom. It is recommended that all cleaning supplies/laundry detergents remain on top shelves and inaccessible to children during day care hours. The 2nd level is the kitchen and living room. the 3rd level are the 4 bedrooms and 2 bathrooms. These areas will be off limits to children in care as well as the garage.. These areas will be inaccessible to children in care by closed and/or locked doors and visual supervision and a safety gate at the top and bottom of the stairs leading to the first level family room/day care area. Applicant's husband Peter Douglas Johnson owns the home; proof was shown. Per applicant, Peter no longer resides in the home. Per applicant there are no firearms/weapons located on the premises. There is a 2A10BC fire extinguisher in the home and a working smoke alarm/ carbon monoxide detector combo which was tested today and is in working condition; recommended periodic servicing. There are no swimming pools, hot tubs or other bodies of water located on the premises. All sharp knives, cleaning solutions and medications are inaccessible to children in care. First aid kit is available and complete. The isolation area for sick children will be an area in the day care room. Outdoor play will be in the fully fenced backyard. Due to the structure of the backyard, physical adult supervision is required when children are at play in the backyard. There are toys and play space available. Applicant was instructed to conduct and document periodic fire and disaster drills. Applicant was informed that baby walkers, exersaucers and baby bouncers are not allowed. Applicant has completed CPR and first aid training which expires in 1/2025 respectively. Applicant has completed her 16 hours of health and safety training which included the 1 hour of Nutrition and 1 hour of Lead poisoning training. DURING TODAY'S PRE-LICENSING INSPECTION THE NEWLY IMPLEMENTED INFANT SAFE SLEEP REGULATIONS WERE DISCUSSED AND MATERIALS WERE GIVEN. APPLICANT DOES NOT WISH TO CARE FOR INFANTS AT THIS TIME. All forms can be downloaded at www.ccld.ca.gov. www.myccl.gov for day-care updates.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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: JOHNSON, YUKA	FACILITY NUMBER: 073409385
	VISIT DATE: 03/15/2023

NARRATIVE

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Mandated reporter and appeal rights were discussed. Licensing forms were reviewed and copies given to applicant. Applicant was reminded 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.
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) 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

As a result of today's visit the following needs to be corrected before a license can be issued.

1. The fire place screen needs to be secured to the wall to prevent access to children in care.
2. The Agave plants (with thorns) located in the backyard needs to be made inaccessible to children in care or removed altogether..

An exit interview was conducted

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC809 (FAS) - (06/04)

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