384004277-7-22-2022-05-CC-NGAA-CGKREH-20220722125733

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004277
Report Date: 07/22/2022
Date Signed: 07/22/2022 12:58:53 PM

Document Has Been Signed on 07/22/2022 12:58 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	WILLIAMS, TESSA MARIE		FACILITY NUMBER:	384004277
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 2	DATE:	07/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Tessa Williams		TIME COMPLETED:	01:00 PM

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On July 22, 2022 at 8:40 AM, Licensing Program Analyst (LPAs) Garcia and Van arrived at the facility to conduct an unannounced Annual Inspection on this day, in conjunction of the complaint investigation and met with the Licensee Tessa Williams. Purpose of the inspection was explained. Present there were 1 child in care with Licensee and her infant child. During the inspection, another preschool aged child arrived at the facility. Licensee was operating in compliance to the required licensed capacity and ratio limits as of today. Per Licensee, the 2 bedroom and 2 bathroom unit, 1 bedroom and bathroom on the ground floor and 1 bedroom and bathroom on the second floor. LPAs verified the background check clearance of the adults working or living in the home. The hours of operation are: M-F, 8:30 AM – 5:30 PM. Licensee provides AM snacks, lunch, and PM snacks.

Daycare areas: Living Room, 1 bedroom and Bathroom. Off Limit areas: 1 Bedroom and bathroom upstairs and Kitchen. LPAs and Licensee inspected the entire childcare area for Health and Safety hazards. LPAs observed that off limit areas were properly barricaded and made inaccessible to the children in care. There was a combined carbon monoxide and smoke detector in the home. LPAs performed the tests to check the functionality of the detector. A fire extinguisher of size 2A10BC or bigger was also available in the home. First Aid kit is fully stocked and accessible. Per Licensee, there are no firearms or weapons in the home. Licensee states, there are no bodies of water in the home.

LPAs observed that the house is in good repair and free of hazards with proper temperature and ventilation. LPAs observed that there is a variety of age-appropriate toys, books, and other learning material available in the home for the children in care. Electric outlets have been secured with child protective covers, and a working phone is on site.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WILLIAMS, TESSA MARIE	FACILITY NUMBER: 384004277
	VISIT DATE: 07/22/2022

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All posting requirements are met and posted near the childcare entrance. Licensee has current and valid CPR and First Aid card expiring on 3/19/24. LPAs reviewed facility records including all children's files present today. LPAs observed that files have records of immunization, names, addresses and telephone numbers of each child's authorized representative.

Licensee was reminded that all adults 18 and over living or working in the home, 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: www.ada.gov/childqanda.htm.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensees were informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Effective July 1, 2020, Licensees must have proof of completion of EMSA certified lead poison training if applying for a change of location or capacity change to an existing license.

LPAs encouraged the Licensee to visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WILLIAMS, TESSA MARIE	FACILITY NUMBER: 384004277
	VISIT DATE: 07/22/2022

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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.

A receipt confirmation is necessary, and a site visit notification must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

LIC809 (FAS) - (06/04)

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