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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700338
Report Date: 09/07/2021
Date Signed: 09/07/2021 03:39:26 PM

Document Has Been Signed on 09/07/2021 03:39 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:HARTMANN, MELANIEFACILITY NUMBER:
435700338
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
09/07/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Melanie HartmannTIME COMPLETED:
04:00 PM
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On 9/7/2021 at approximately 2:25 PM, Licensing Program Analyst (LPA) Melanie Otsuji met with licensee, Melanie Hartmann for an UNANNOUNCED CAPACITY INCREASE INSPECTION. Present for this visit was fingerprint husband, John Abu Sharkh. LPA toured the home to conduct a health and safety inspection. The facility operates between the hours of 8:00 AM-5:30 PM, Monday -Friday

On-limit-areas are the: Child Care Room and bathroom, sunroom, front entry room, and backyard

Off-limit-areas are : Kitchen, Living and dining room, all bedrooms and other bathrooms, laundry room, garage, and gated side-yard with shed.

The Kitchen Area of the home which will be inaccessible by closed and/or locked doors, safety gates and visual supervision. The Isolation area will be a section of the front entry room, away from other children in care. The outdoor play area is the fully fenced backyard area. The off-limits are will be made inaccessible by closed and/or locked doors and visual supervision.

There are ample age appropriate toys that are safe and in good condition. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection.

The home has a fully charged 3A40BC fire extinguisher, dual working smoke detector/ carbon monoxide detector, first aid kit and telephone. The fireplace is blocked to prevent access by children and there are no heaters accessible to children in care. Per licensee, there are firearms in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers. All required forms are posted and visible for public review.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2021
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: HARTMANN, MELANIE
FACILITY NUMBER: 435700338
VISIT DATE: 09/07/2021
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Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of her responsibility as mandated reporter. California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone.

LPA informed the licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The licensee was also reminded that Mandated Reporter Training is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

LPA reviewed (1) children's file. CPR/First Aid is also renewed every two years with current CPR/First aid expiring on 3/6/2023. Baby bouncers & drop-down cribs are not allowed at the day-care facility. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. LPA Otsuji has provided Licensee with a copy of new safe sleep regulations and a copy of the LIC9227 (Individual Infant Sleeping Plan).

Incidental Medical Services (IMS) policy was discussed. 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.



The fire clearance for the increase in capacity was received and approved on 8/19/2021 by City of Mountain View Fire Department.
No deficiencies are being cited. This home is recommended for the capacity increase as of today's date, 9/7/2021. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. This report shall remain on file for 3 years. Exit interview conducted with licensee. Notice of Site Visit provided and must be posted for 30 days.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021
LIC809 (FAS) - (06/04)
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