010212886-7-14-2023-52-CC-LDBX-CTQVNY-20230714163557

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010212886
Report Date: 07/14/2023
Date Signed: 07/14/2023 04:36:02 PM

Document Has Been Signed on 07/14/2023 04:36 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:	LENZ, VICTORIA		FACILITY NUMBER:	010212886
ADMINISTRATOR:	LENZ, VICTORIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 462-2990
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94566
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 3	DATE:	07/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Victoria Lenz		TIME COMPLETED:	04:45 PM

NARRATIVE

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On July 14, 2023 at 3:10pm 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. Present during the inspection was licensee and licensee's adult and fingerprint cleared son. LPA toured the home to conduct a health and safety inspection. Required postings were all present. 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/back yard. The isolation area is in the family room. Off-limit-areas are the: Backyard deck off the bedroom, garage, and all 4 bedrooms. The off-limits areas will be made inaccessible by closed and/or locked doors and visual supervision. The backyard is fully fenced. There is a jacuzzi in the rear yard has a cover with the appropriate locks.

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 (kitchen), working smoke detector, working carbon monoxide detector, fully stocked first aid kit, and telephone. There’s a fireplace that has a barricade to prevent access by children in the child care room. Per licensee, there are no firearms in the home. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored and inaccessible to children.

809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LENZ, VICTORIA	FACILITY NUMBER: 010212886
	VISIT DATE: 07/14/2023

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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.

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.

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.

Licensee’s Health and Safety training has been completed and Pediatric CPR and First Aid training is completed. Licensee’s Mandated Reporter training is complete and expires 4/16/2024. A fire/disaster drill was conducted since 7/5/23. All required forms are posted and visible for public view.

809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LENZ, VICTORIA	FACILITY NUMBER: 010212886
	VISIT DATE: 07/14/2023

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Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's parents, and to the Department using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or email. Licensee was reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting https://mandatedreporterca.com/. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.

During the exit interview, the Licensee, Victoria Lenz, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights Provided. There are no citations issued on today's date.

Exit interview conducted and report was reviewed with the licensee Victoria Lenz.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC809 (FAS) - (06/04)

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