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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214703
Report Date: 05/04/2023
Date Signed: 05/04/2023 12:23:13 PM

Document Has Been Signed on 05/04/2023 12:23 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:CAMERON, COSSETTE & WILLIAMFACILITY NUMBER:
010214703
ADMINISTRATOR:CAMERON, COSSETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 881-8603
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 4DATE:
05/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:04 AM
MET WITH:Cossette Cameron- LicenseeTIME COMPLETED:
12:35 PM
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On 5/4/23, Licensing Program Analyst (LPA) B. Plumboy conducted an unannounced ANNUAL/RANDOM inspection. Present for the inspection was licensee Cossette Cameron and 4 preschool age children. The home was toured for Health and Safety Inspection. This facility currently operates from Monday through Friday, 7:30am until 6:00pm.

The OFF LIMITS area is the garage. There is a swimming pool in the backyard with a fence surrounding the area and self latching gate. There is also another gate on the bottom stairway leading up to the pool. There are no firearms on the premises as stated by licensee. All the cleaning products during the inspection were observed to be stored and made inaccessible to the children. The fireplace is barricaded with a glass door and is not currently being used by the licensee. LPA inspected and verified that the fire extinguisher 3A40BC is fully charged, carbon monoxide detector, smoke detector and home phone are in working condition. Backyard play area is properly fenced and there are toys available for children to use during today's inspection. There are toys, learning materials and kids furniture that appeared to be well maintained during today's inspection. The licensee has completed the required training on preventive health practices including pediatric CPR and First Aid which expires on 2/19/25. Children's roster is current and available. Fire and disaster drills are being conducted regularly with the last one conducted on 4/12/23 with 6 children. The licensee is in compliance with the immunization law. The licensee completed the mandated reporter training on 7/9/21. The licensee is aware she must document safe sleep checks while infants are asleep at least every 15 minutes.

See 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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: CAMERON, COSSETTE & WILLIAM
FACILITY NUMBER: 010214703
VISIT DATE: 05/04/2023
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Incidental Medical Services (IMS) policy was discussed. 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: http://www.ada.gov/childqanda.htm

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, 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 the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA discussed the safe sleep regulations with licensee Cossette Cameron 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 Cossette Cameron 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.

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

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Cossette Cameron.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
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