010213948-5-3-2024-02-CC-ILOA-D4WQAA-20240503115938

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010213948
Report Date: 05/03/2024
Date Signed: 05/03/2024 11:59:51 AM

Document Has Been Signed on 05/03/2024 11:59 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	PEREZ, ANA MABEL		FACILITY NUMBER:	010213948
ADMINISTRATOR/ DIRECTOR:	PEREZ, ANA MABEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 524-3465
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94707
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 12	DATE:	05/03/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:10 AM
MET WITH:	Ana Mabel Perez		TIME VISIT/ INSPECTION COMPLETED:	12:15 PM

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On May 3, 2024 at 9:10am, Licensing Program Analyst (LPA) Indira Loza arrived at the facility for an unannounced Random/Annual inspection. LPA met with Licensee Ana Mabel Perez. The Licensee lives in the home with her adult son. Present during today's inspection were 9 preschool age children, 3 infants, the Licensee's adult son/assistant Nicholas Lopez, and assistant Maria Valdez. All adults have been fingerprinted and have a cleared background check. The licensee operates Monday - Friday 8am - 5pm.

LPA toured the daycare areas of the home for a health and safety check. LPA observed that the home is neat and clean with heating and ventilation for the safety and comfort of children. The home is a single story family house consisting 4 bedrooms, 3 and a half bathrooms, a den, and a detached garage

The Off Limit Areas - All 4 bedrooms and 1 and a half bathroom .The off limits areas are made inaccessible by gate, closed and/or locked doors and visual supervision.

The On Limit Areas - the backyard, detached garage, den (main daycare area), bathroom connected to the den, and bathroom next to the detached garage.

Isolation Area - the garage

Inside the home the LPA observed an ample supply of age appropriate toys, activities and equipment for children, which appeared to be safe and in good condition. LPA did not observe any medication, bodies of water, or poisons accessible to children during the inspection today. Per licensee there are no firearms in the home. The home is equipped with a fully charged 2A10BC fire extinguisher. The Licensee has an EMSA approved CPR certificate which expires on 2/2024. The licensee provides two snacks to the children in care and lunch is brought from home. LPA verified the applicant's phone number and email on record are correct. There was a working carbon monoxide detector. Licensee's Mandated Reporter Certificate which expires 4/2024. The backyard is utilized for outdoor play. There is a tree house in

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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: PEREZ, ANA MABEL	FACILITY NUMBER: 010213948
	VISIT DATE: 05/03/2024

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the backyard and plenty activities to help the children develop their gross motor skills. LPA reviewed 6 children files and all staff files. The staff files were complete but 3 of 6 children files reviewed were missing a signed receipt of the Parent's Rights (LIC995).

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.

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.

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.

For Incidental Medical Service (IMS) information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: PEREZ, ANA MABEL	FACILITY NUMBER: 010213948
	VISIT DATE: 05/03/2024

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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.

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

There were no deficiencies cited during today's visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Assistant Nicholas Lopez.
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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

LIC809 (FAS) - (06/04)

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