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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010212886
Report Date: 08/07/2024
Date Signed: 08/07/2024 11:47:03 AM

Document Has Been Signed on 08/07/2024 11:47 AM - 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, VICTORIAFACILITY NUMBER:
010212886
ADMINISTRATOR/
DIRECTOR:		LENZ, VICTORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 462-2990
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
08/07/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Victoria LenzTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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On August 7, 2024, 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 and daughter and minor granddaughter. LPA toured the home to conduct a health and safety inspection. Upon arrival LPA provided licensee a copy of the Entrance Checklist (LIC 126). The facility plans to operate between the hours of 4:30 AM-6:30 PM, Monday -Friday.

This single-story home, consisting of 4 bedrooms and two bathrooms. The home has heating and ventilation for the safety and comfort of children in care.

On-limit-areas: Living room, family/dining room, both bathrooms (one near family room), one in hallway (main). The isolation area: Section in the family room away from the children in care until the parents arrive.

Off-limit-areas: Rear Yard (off limits due to remodeling), backyard deck off the bedroom, two car 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 hot tub in the rear yard. Licensee is reminded that after the remodeling to contact LPA to inspect the rear yard before using for the day care, especially since there is a hot tub in the rear yard. LPA unable to check the locks on the hot tub due to the remodeling.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged 4A60BC fire extinguisher (kitchen), working dual smoke detector (tested)/carbon monoxide detector, working telephone and fully stocked first aid kit. Per licensee, there are no firearms on the premises. Per licensee she does reside in the home. There is a fireplace in the on-limit living room which is barricaded to prevent accessibility to children in care.

809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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: 08/07/2024
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The licensee completed the Health and Safety training, CPR/First Aid certification expires on 10/28/2025. The licensee is in compliance with the immunization laws and has completed the mandated reporter training. 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 06/02/2024. All required forms are posted and visible for public review.

Records: LPA Dacanay Breaux reviewed one (1) child files and records. Child file is to be found complete Per licensee does not provide care for children under the age of 3 years. There is a current roster available for review and copy obtained. LPA provided licensee with LIC 282.



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.

Per licensee is not administering medication at this time.

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/.

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.


 LIC 809C

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

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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: 08/07/2024
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LPA reminded 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 ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

CCLD Inspection Process: To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

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.

Megan’s Law: 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.

There are no deficiencies cited today. Appeal Rights provided. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Victoria Lenz.

END OF REPORT

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

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC809 (FAS) - (06/04)
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