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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409499
Report Date: 12/22/2023
Date Signed: 12/22/2023 10:32:32 AM

Document Has Been Signed on 12/22/2023 10:32 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:BLACKLOCK, ATCHAFACILITY NUMBER:
073409499
ADMINISTRATOR:BLACKLOCK, ATCHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 301-3957
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/22/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:BLACKLOCK, ATCHATIME COMPLETED:
11:00 AM
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On December 22, 2023 at 8:50AM Licensing Program Analyst (LPA) Nyeesha Blount conducted an unannounced case management visit for change of location. LPA met with Applicant Blacklock, Atcha who is background cleared no children were present during today's inspection. LPA toured the home with Applicant for a Health and Safety inspection. Applicant has applied for a Change of Location for a Large Family Child Care Home with capacity for 14 children. Days and hours of operation will be Monday through Friday from 8:00 AM - 5:30 PM. Applicant has current Pediatric cardiopulmonary resuscitation (CPR) and First Aid. Applicant has a fully stocked first aid kid. Applicant has current mandated reporter training which expires on 12/2024. Applicant currently rents this property. Applicant has a working telephone in the home.(510-542-4253) Isolation of sick child will be the first bedroom to the right of the living room. Applicant understand that 100% supervision is required at all times. Applicant has an approved fire clearance dated 12/20/23. Fire clearance is approved for 14 children. Fire clearance indicates that clearance is granted for the first floor only and is not approved for the garage. Applicant applied for change of location because prior location landlord would not fix or make any repairs to the property. LPA observed that the classroom has sufficient lighting and an ample supply of age appropriate toys, activities and furniture. The facility has a functioning centralized fire system, carbon monoxide detector, (1)fully charged 2A10BC and (2) 1A10BC fire extinguisher.
ON LIMIT AREAS: (1) bedroom, (1) bathroom, living room, dining room, kitchen, play room (day care room) and fenced back yard.

OFF LIMIT AREAS: Entire upstairs of the home secured with gates made inaccessible to children in care.
Licensed effective 12/22/23
There are no deficiencies cited today. An exit interview was conducted. Appeal rights were given and discussed. A site visit notice was given and posted.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2023
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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