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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700372
Report Date: 12/22/2022
Date Signed: 12/22/2022 03:10:03 PM

Document Has Been Signed on 12/22/2022 03:10 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:BIRD, BARBARAFACILITY NUMBER:
435700372
ADMINISTRATOR:BIRD, BARBARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 704-1488
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Barbara BirdTIME COMPLETED:
11:30 AM
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On 12/22/2022 at 9:00am, Licensing Program Analyst (LPA) Christina Uribe met with applicant Barbara Bird for the purpose of conducting an announced pre-licensing inspection for a change of location. Present during today’s inspection is the applicant, the applicant’s fingerprint cleared & associated daughter-in-law, Melanie Hartmann, and two grandchildren under the age of 18 years. The home was toured for a health and safety inspection.

On-Limit Areas: Two adjoining day care rooms, bathroom, & backyard. Off-Limit Areas: Kitchen, living room, 3 bedrooms, bathroom, sun room, laundry room, and garage. The garage has been previously renovated but per the Mountain View Fire Department, the fire clearance clearly states that the converted garage will not be used for day care purposes under any circumstances.

The facility is a one story home consisting of 3 bedrooms, 2 bathrooms, kitchen, living room, laundry room, and two rooms dedicated for the day care space. The laundry room will be off limit but can be used for parents who come to drop off or pick up their children as the laundry room is connected from the outside of the home. The day care rooms have their own entrance from the front of the home. All rooms are neat and clean with heating and ventilation for safety and comfort. The off-limits areas will be made inaccessible by closed and/or locked doors and visual supervision.

The outdoor play area is located in the applicant’s backyard and is fully fenced and in good condition with no hazardous materials accessible to children in care. There are no pools, hot tubs, or any other bodies of water present in the on-limit areas during today’s inspection.

There are ample age-appropriate toys that appear to be safe and in good condition. The home is equipped with a fully charged 2A10BC fire extinguisher, functional carbon monoxide detector, smoke detector, & telephone. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. There is a fireplace located in the on-limit day care room that is barricaded to prevent accessibility to children in care. There is also another fireplace in the off-limit living room.
Page 1 of 3 **Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: BIRD, BARBARA
FACILITY NUMBER: 435700372
VISIT DATE: 12/22/2022
NARRATIVE
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Per licensee, there are no firearms in the home during today’s inspection. There is a dog at the home that will be kept in the off limit areas. The applicant is in compliance with the immunization laws which pertain to all childcare providers. All required forms are posted and visible for public review. Applicant completed and received certificates for Mandated Reporter Training & Pediatric CPR/First-Aid Training and was reminded of their responsibility to renew each training every two years.

Records to be Maintained: LPA reviewed the Packet of Records to be Maintained with applicant and thoroughly discussed each page and section for clarification and consultation. Applicant understands their responsibility for maintaining personnel and children's records, keeping complete and separate records for each child, and making them available for review upon request to the Licensing Department. LPA reviewed Personal Rights, Parents' Rights, Reporting Requirements, & Inspection Authority with the applicant.

PROVIDING IMS: This facility plans on providing Incidental Medical Services (IMS). For IMS information see Evaluator Manual – Regulations Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department.

Applicant/Licensee Responsibility: As stated on the signed Application for Family Child Care Home License (LIC 279) form, applicant is reminded of the following terms; Stay current and in compliance with the laws and regulations governing standards for Family Child Care Homes. Obtain approval from the licensing agency before making changes in the license capacity or to the home. Notify the licensing agency if wish to discontinue the license.

Additionally, applicant is reminded that once licensed, the license and facility license number is just as connected to this residence at 1307 Ernestine Lane, Mountain View, Ca as it is to the licensee’s name. Licensee must notify the licensing agency prior to moving to another location and to fill out a new application for a change of location. Licensee is reminded that child care services cannot be provided at any other location without approval from the licensing agency.

LPA informed applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the applicant to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

Page 2 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
Page: 2 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: BIRD, BARBARA
FACILITY NUMBER: 435700372
VISIT DATE: 12/22/2022
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Baby bouncers & drop-down cribs are not allowed at the daycare facility. Roster of children & their records must be properly maintained & available for review at all times. A fire/disaster drill must be performed and recorded every 6 months. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to the Community Care Licensing. The licensee was provided information regarding the effects of Lead Exposure and testing requirements (Assembly Bill 2370).

Applicant 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.

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-and-resources/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.

Effective August 1, 2003 California Law requires Child Care 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 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

All documents have been received for the change of location application. The fire clearance for a capacity of 14 children was received from the Mountain View Fire Department. The licensee was reminded to abide by the conditions of the fire clearance. The licensee is reminded that prior to accepting more than 8 children into care, an assistant must be present. Whenever the assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

This home is recommended for Licensure on 12/22/2022. This report shall remain on file for 3 years. Exit interview was conducted with applicant, Barbara Bird.

Page 3 of 3 ***End of Report***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
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