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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423650
Report Date: 05/09/2024
Date Signed: 05/09/2024 05:16:17 PM

Document Has Been Signed on 05/09/2024 05:16 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:CASTRO, ANAFACILITY NUMBER:
013423650
ADMINISTRATOR/
DIRECTOR:		CASTRO, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 512-6467
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
05/09/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Ana CastroTIME VISIT/
INSPECTION COMPLETED:
05:25 PM
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On May 9, 2024 Licensing Program Analyst (LPA) Indira Loza met with Licensee Ana Castro for an Annual/Random inspection. Present during today's inspection were the Licensee, Assistant Telma Galicia, Assistant Laura Romeno, 9 preschoolers, and four infants. The applicant lives alone. The home was toured for a Health and Safety check. The facility operates from 8am-5pm, Monday – Friday.

The home is a single story house consisting of two bedrooms, one bathroom, and a fully fenced in backyard.

ON LIMITS AREA: The first bedroom on the right of the hallway (nap room), bathroom, living room, kitchen, and the backyard.
OFF LIMITS AREA: The bedroom on the left of the hallway.
ISOLATION AREA: The Naproom

The inside of the home is observed to be neat, clean with ample age-appropriate materials for the children. All toxins and cleaning products were observed to be in inaccessible areas. Licensee stated she provides breakfast, lunch, and afternoon snack. All food that may be brought from the children’s home will be properly labeled and stored. Licensee uses child sized table for eating that were observed to be clean and well maintained. LPA observed four play yards to be used for sleeping which as observed to be well maintained. All off limit areas are made inaccessible with closed doors and locks. Per Licensee there are no firearms in the home.

The home has one fully charged 3A40BC fire extinguisher on the kitchen counter. There is a working combined smoke detector and carbon monoxide in the kitchen. The home is equipped with central heat and air for proper ventilation. The fireplace in the living room is blocked off with a children's storage shelf making it inaccessible to the children in care. The backyard is fully fenced and is utilized for outdoor play. LPA observed ample materials for the children in care. There were no harmful bodies of water in or around the


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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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: CASTRO, ANA
FACILITY NUMBER: 013423650
VISIT DATE: 05/09/2024
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home. The Licensee stated she currently does not have Liability Insurance, all children files had the "Affidavit Regarding Liability Insurance in Family Child Care Homes" (LIC282). Licensee’s Health and Safety training has been completed and EMSA approved Pediatric CPR & First Aid has been completed and expires July 2025. Licensee’s Mandated Reporter has been completed and expires February 22, 2025. Fire/disaster drills have been conducted and recorded with the last drill logged March 14, 2024. All required forms are posted and visible for public view in the hallway. LPA reviewed three staff files and five children files. All files were found to be complete. The Licensee is keeping sleep logs for the infants.

Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's parents, and to the Department within 24 hours by phone. Within seven (7) days from the incident, Licensee’s must submit the Unusual Incident/Injury form (LIC 624B) to the Department. Licensee was reminded that any structural changes or additions to the home must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting https://mandatedreporterca.com/. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.



Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, 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.
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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
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: CASTRO, ANA
FACILITY NUMBER: 013423650
VISIT DATE: 05/09/2024
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.
During the exit interview, Licensee Ana Castro, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

LPA informed Licensee Castro that this report dated 05/9/24 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the safety of children in care. LPA also informed the Licensee to provide a copy of this licensing report, dated 05/9/24 documenting a Type A citation, to parents/guardians of all children currently enrolled by the next business day, or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or another written statement, must be placed in the child's file for verification.

See LIC809-D for the Type A deficiency.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted. Report and Appeal Rights was reviewed with the Licensee Ana Castro.

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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/09/2024 05:16 PM - It Cannot Be Edited


Created By: Indira Loza On 05/09/2024 at 04:46 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CASTRO, ANA
FACILITY NUMBER: 013423650

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)(2)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in there were 4 infants and 9 preschoolers which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/10/2024
Plan of Correction
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The Licensee shall bring the ratio into compliance before the close of business on 5/9/24. Also, LPA will be visitng the facility within 10 days to ensure ratio compliance.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2024


LIC809 (FAS) - (06/04)
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