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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409720
Report Date: 12/18/2024
Date Signed: 12/18/2024 11:59:54 AM

Document Has Been Signed on 12/18/2024 11:59 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:TSO, LHAMOFACILITY NUMBER:
073409720
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
12/18/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Lhamo Tso & Lhamo DolmaTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On December 18, 2024, Licensing Program Analyst (LPA) Indira Loza arrived at the facility for an announced prelicensing inspection. LPA met with applicant Lhamo Tso and her adult daughter Lhamo Dolma. The applicant lives in the home with her husband Dhondup Wangchen, adult daughter, and minor grandchild. The applicant has two Shih Tzu dogs and 5 chickens. LPA toured the home for a health and safety check. The applicant plans to care for children ages 3 months - 5 years old, and plans to operate on Monday - Friday from 7:30am - 5:30pm .

The home is a two story single family house. The lower level of the home includes a small room at the entrance of the home, kitchen, living room, bathroom, garage converted to a den, and a patio leading from the living room. The second level of the home includes two bedrooms and two bathrooms.

The Off Limit Areas: are the kitchen (only to be used as a pathway for the children to walk through so they can access the bathroom), the den, the basement, the entire backyard and walkways on the sides of the house. The off limits areas are made inaccessible by gate, closed and/or locked doors and visual supervision.


The On Limit Areas are the entry room, living room, downstairs bathroom, and the back patio.
Isolation Area - in the entry room

Inside the home the LPA observed an ample supply of age appropriate toys, activities and equipment for children, which appeared to be safe and in good condition. The main daycare area is the living room and the entry room. The applicant plans on using the entry room for the nap room. LPA did not observe any medication, bodies of water, or poisons accessible to children during today's inspection. Per applicant there are no firearms in the home. The home is equipped a fully charged 2A10BC fire extinguisher next to the sliding doors leading to the patio. There is a working smoke detector in the hallway between the kitchen and the living room and a carbon monoxide detector in the living room. The applicant's CPR certificate expires 1/13/26 and the applicant's Mandated Reporter certificate expires on 3/1/26.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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: TSO, LHAMO
FACILITY NUMBER: 073409720
VISIT DATE: 12/18/2024
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The applicant plans on utilizing the patio for outdoor play. There are two sets of stairs leading to the backyard and they have child safety gates. There is also a child safety gate leading from the living room to the hallway - the hallway leads to a set of stairs, and there is a small set of stairs going to the patio. All stairs have a child safety gate preventing children from accessing them. The home has a central heating system, there was not a wall heater or a fire place in the home. The applicant plans to provide food for the children.

LPA reviewed all of the forms required for the children's files, facility file, posting and other information related to Licensing and the care of children. LPA left copies with the applicant. LPA advised the applicant of where to obtain additional copies of the forms. Applicant was reminded that the required documents must be visible for the public at all times during hours of operation. A copy of the Entrance Checklist (LIC126) was provided to the applicant.

LPA reviewed children's personal rights and the applicant confirmed that she understands that children's personal rights should not be violated and no corporal punishment is allowed. LPA reminded the applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. LPA reminded the applicant to report any injuries requiring medical attention or unusual incidents to the Oakland Regional Child Care office. LPA reviewed the form to follow up in writing within 7 days of the injury/unusual incident. The applicant was encouraged to periodically review regulations, guidelines and PINS on the website www.ccld.ca.gov.

Applicant 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, 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 Family 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
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: TSO, LHAMO
FACILITY NUMBER: 073409720
VISIT DATE: 12/18/2024
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LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed applicant 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.

On December 18, 2024 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.


To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication
The applicant owns the home and has provided proof of homeownership.

A license for a small family child home is being granted and is effective today, December 18, 2024
Exit interview conducted. Report reviewed and provided to Licensee Lhamo Tso.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC809 (FAS) - (06/04)
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