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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700372
Report Date: 08/29/2024
Date Signed: 08/29/2024 01:56:46 PM

Document Has Been Signed on 08/29/2024 01:56 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BIRD, BARBARAFACILITY NUMBER:
435700372
ADMINISTRATOR/
DIRECTOR:		BIRD, BARBARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 704-1488
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 11DATE:
08/29/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Barbara BirdTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On 08/29/2024 at 9:15am Licensing Program Analyst (LPA) Christina Uribe, met with licensee Barbara Bird for an UNANNOUNCED ANNUAL INSPECTION. Present for the inspection were 11 daycare children and 1 fingerprint cleared assistant (Sreevalli Tella). The licensee is within ratio today with 4 infants and 7 older children. Upon arrival LPA provided licensee a copy of the Entrance Checklist (LIC 126). The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday-Friday 7:30am-5:30pm.

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.
On-Limit Areas: Two adjoining day care rooms, bathroom, & backyard.

Off-Limit Areas: Kitchen, living room, 3 bedrooms, bathroom, sun room, laundry room, and attached 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’s outdoor play space is located in the backyard of the home. The play structure, equipment, and fence are all in safe condition free from hazards which could pose a risk to children in care. There is ample shade available and gates are closed at all times while children are in the yard.

Page 1 of 4 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BIRD, BARBARA
FACILITY NUMBER: 435700372
VISIT DATE: 08/29/2024
NARRATIVE
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All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, carbon monoxide detector, telephone and fully stocked first aid kit. There are no pools, hot tubs or any other bodies of water present at the time of the inspection. Per licensee, there are no firearms on the premises.

The licensee's CPR/First Aid certificate expires on 11/04/25 and mandated reporter certificate expires on 11/12/25. Licensee is reminded of their responsibility to renew CPR/First Aid and Mandated Reporter certificates every two years. The licensee conducts and documents fire and disaster drills twice a year and the last conducted drill was on 08/09/24.

Records: LPA Uribe reviewed 11 children’s files and personnel records. Individual Infant Safe Sleep Plans are complete for all infants under 12 months of age. Facility roster was reviewed. The facility does have liability insurance which is valid through 03/01/25. Licensee is reminded to obtain revised admission documents for children when the child’s home address or any other personal information changes.



Provider Information Notices (PINs) & Quarterly Updates: 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 communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email notifications.

CCLD Inspection Process: 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.

Page 2 of 4 ***Continued on LIC 809C***

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

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BIRD, BARBARA
FACILITY NUMBER: 435700372
VISIT DATE: 08/29/2024
NARRATIVE
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Criminal Record Clearance: 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.

Safe Sleep: 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.

Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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/resources/child-care-centers/.

MyChildCarePlan.org: Licensee was informed of the MyChildCarePlan.org website; 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.

Unusual Incident/Student Injury Report: 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.

Page 3 of 4 ***Continued on LIC 809C***

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

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BIRD, BARBARA
FACILITY NUMBER: 435700372
VISIT DATE: 08/29/2024
NARRATIVE
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Megan’s Law: During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Four (4) Deficiencies and Six (6) Advisory Notes issued during today's inspection:

  • Type B Violation: One infant was observed to be using a sleep sack during nap.
  • Type B Violation: Immunization records are incomplete/missing for 10 children's files.
  • Type B Violation: Emergency information records are incomplete/missing for 8 children's files.
  • Type B Violation: 15-minute checks on sleeping infants are not being recorded on sleep logs.
  • Advisory Note (TV): Baby bouncers were observed in on-limit room.
  • Advisory Note (TV): Notification of Parents' Rights Poster (PUB 394) not posted for public review.
  • Advisory Note (TV): Employee Rights (LIC 9052) form needed for assistant.
  • Advisory Note (TV): Updated immunization records needed for assistant.
  • Advisory Note (TV): Facility Roster (LIC 9040) incomplete and needs to be updated.
  • Advisory Note (TV): All children's files are missing a signed Parents' Rights (LIC 995A) form.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal rights were given and reviewed. Exit interview conducted and report was reviewed with the licensee, Barbara Bird.

Page 4 of 4 ***End of Report***

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

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC809 (FAS) - (06/04)
Page: 4 of 13
Document Has Been Signed on 08/29/2024 01:56 PM - It Cannot Be Edited


Created By: Christina Uribe On 08/29/2024 at 12:37 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: BIRD, BARBARA
FACILITY NUMBER: 435700372

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
N/A
POC Due Date: 08/29/2024
Plan of Correction
1
2
3
4
Type B
Section Cited
CCR
102425(f)
Infant Safe Sleep
An infant shall not be swaddled while in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as LPA observed one infant swaddled by way of the use of a sleep sack which poses/posed a potential health, safety or personal rights risk to persons in care. Sleep sacks are considered a form of swaddling and are not allowed to be used in a licensed family child care home.
POC Due Date: 09/27/2024
Plan of Correction
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Licensee will inform all parents and assistants that sleep sacks are not allowed to be used for infants as it is a form of swaddling. Licensee will create a written statement acknowledging the restriction of sleep sacks for infants and that all parents and assistants have been informed that sleep sacks will no longer be allowed. Licensee will email this written statement to LPA Uribe at christina.uribe@dss.ca.gov no later than 09/27/2024.
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:Chandra Charles
LICENSING EVALUATOR NAME:Christina Uribe
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/29/2024 01:56 PM - It Cannot Be Edited


Created By: Christina Uribe On 08/29/2024 at 12:37 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: BIRD, BARBARA
FACILITY NUMBER: 435700372

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited above as 3 children's immunization records need to be updated and immunization records were missing for 7 children's files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2024
Plan of Correction
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Licensee will obtain a current copy of all children's immunization records from their parents/guardians and place these records in the children's files. Licenseee will create a written statement acknowledging the requirement to maintain immunization records at all times, obtain updated immunization records as needed, and how licensee will meet this requirement. Licensee will email this written statement to LPA Uribe at christina.uribe@dss.ca.gov no later than 09/27/2024.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as 2 children had incomplete/missing Identification & Emergency (LIC 700) forms and 8 children had incomplete/missing Consent for Emergency Medical Treatment (LIC 627) forms which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2024
Plan of Correction
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Licensee will ensure that all children's files have a complete and accurate Identification & Emergency (LIC 700) form and Consent for Emergency Medical Treatment (LIC 627) form. Licensee will create a written statement acknowledging the requirement to maintain and plan to maintain identification and emergency documentation for each child at all times. Licensee will email this written statement to LPA Uribe at christina.uribe@dss.ca.gov no later than 09/27/2024.
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:Chandra Charles
LICENSING EVALUATOR NAME:Christina Uribe
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024


LIC809 (FAS) - (06/04)
Page: 6 of 13
Document Has Been Signed on 08/29/2024 01:56 PM - It Cannot Be Edited


Created By: Christina Uribe On 08/29/2024 at 12:37 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: BIRD, BARBARA
FACILITY NUMBER: 435700372

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above as documentation of 15-minute checks for sleeping infants are not being performed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2024
Plan of Correction
1
2
3
4
Licensee will create a written statement acknowledging the requirement to document each 15-minute check for sleeping infants and a plan on how this requirement will be met. Licensee will email this written statement to LPA Uribe at christina.uribe@dss.ca.gov no later than 09/27/2024.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
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2
3
4
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:Chandra Charles
LICENSING EVALUATOR NAME:Christina Uribe
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024


LIC809 (FAS) - (06/04)
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