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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010212886
Report Date: 07/27/2021
Date Signed: 07/27/2021 03:43:32 PM

Document Has Been Signed on 07/27/2021 03:43 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:LENZ, VICTORIAFACILITY NUMBER:
010212886
ADMINISTRATOR:LENZ, VICTORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 462-2990
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Victoria LenzTIME COMPLETED:
04:05 PM
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On July 27, 2021, at 02:20 PM., Licensing Program Analyst (LPA) Lorraine Dacanay Breaux conducted an unannounced Annual Required Inspection and met with licensee, Victoria Lenz. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection was licensee's adult and fingerprint cleared daughter. 7 (seven) children, two 7 years, one 12, two 10 years old, one 4 and 2 years old. LPA toured the home to conduct a health and safety inspection. The facility plans to operate between the hours of 5:30 AM-6:30 PM, Monday -Friday.

This single-story home, which is neat and clean with heating and ventilation for safety and comfort. On-limit-areas are the: living room, family/dining room, both bathrooms (one near family room), one in hallway and back yard.

Off-limit-areas are the: Backyard deck is off limits, garage, and all 4 bedrooms.

The isolation area is in the family room.

The off-limits ares will be made inaccessible by closed and/or locked doors and visual supervision.

Required postings were all present. Postings included:
License
Emergency Disaster Plan
Earthquake checklist
Notification of Parents Rights
Seat belt safety laws

There are ample amount of appropriate toys that appear to be safe and in good condition. There is a hot tubs that is locked and inaccessible to children. No 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 4A60BC fire extinguisher, working smoke detector, working carbon monoxide detector, first aid kit and telephone.
Per licensee, there are no firearms in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers.

See 809-Continuation
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2021
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: LENZ, VICTORIA
FACILITY NUMBER: 010212886
VISIT DATE: 07/27/2021
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Licensee's CPR and First Aid certificate is current and expires 05/01/2023. The licensee has completed and received a certificate in mandated reporter training on 05/02/2021. All required forms are posted and visible for public review.

The facility roster was reviewed, and copies was obtain. The licensee is in ratio today.

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.

California Law requires Family Child Cares 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 by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

Safe Sleep was discussed and booklet was provided.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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: LENZ, VICTORIA
FACILITY NUMBER: 010212886
VISIT DATE: 07/27/2021
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Roster of the children must be properly maintained and fire/disaster drill every six months must be documented last fire drill was July 1, 2021. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

Incidental Medical Services (IMS) policy was discussed. Per licensee, no IMS is being provided at this time. The licensee was reminded that when any changes to the IMS plan is made, an updated 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.”

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/his responsibility as mandated reporter.

There are no deficiencies cited. This report shall remain on file for 3 years. Exit interview was conducted with the licensee. A Notice of Site visit was posted at the time of inspection and must remain posted for 30 days

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC809 (FAS) - (06/04)
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