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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013414785
Report Date: 02/21/2023
Date Signed: 02/21/2023 02:20:34 PM

Document Has Been Signed on 02/21/2023 02:20 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:PURNELL, DEVVINFACILITY NUMBER:
013414785
ADMINISTRATOR:PURNELL, DEVVINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 708-0797
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
02/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:Devvin PurnellTIME COMPLETED:
02:25 PM
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On February 21, 2023 at 12:28pm Licensing Program Analyst (LPA) Indira Loza met with Licensee Devvin Purnell for an Unannounced Required Annual Inspection. Present during the inspection was the Licensee, her minor child, one infant, and 4 preschool age children in care. The home was toured for a health and safety inspection. The facility operates 24 hours per day, 7 days per week.

The home is a two story house with the daycare operating on the lower level. The lower level consists of a front room, a back room, laundry room, nap room, bathroom and fenced in back yard. The inside of the home was observed to be neat and clean with age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be inaccessible to the child in care.

ON LIMITS AREA: The entire lower level of the home
OFF LIMITS AREA: Entire upper level of the home
ISOLATION AREA: Is in the front room

The home has a fully charged 2A10BC fire extinguisher in the living room, a working combined smoke and carbon monoxide detector. The Licensee's CPR and First Aid certificate is current and expires on March 2023. Per Licensee, there are no firearms in the home. LPA reviewed one staff file, five children's files, and obtained a copy of the facility roster. The children bring their food from home.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual -
Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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
***************************************Report Continues on LIC 809**********************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2023
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PURNELL, DEVVIN
FACILITY NUMBER: 013414785
VISIT DATE: 02/21/2023
NARRATIVE
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(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 not providing IMS at this time.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/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 web page athttps://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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

There were one Type B citations issued during today's visit. See LIC 809-D for the deficiencies.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted
Report and Appeal Rights were provided to Licensee Devvyn Purnell.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 06/27/2023 01:28 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 06/26/2023 04:27 PM


Created By: Indira Loza On 02/21/2023 at 01:52 PM
Link to Parent Document Below:
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: PURNELL, DEVVIN
FACILITY NUMBER: 013414785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Section Cited
Operation of A Family Child Care Home
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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3
4
Deficiency Dismissed
Section Cited
Operation of A Family Child Care Home
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2023


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 02/21/2023 02:20 PM - It Cannot Be Edited


Created By: Indira Loza On 02/21/2023 at 01:52 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: PURNELL, DEVVIN
FACILITY NUMBER: 013414785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in one out of one infant had a blanket in the crib which poses a potential safety risk to persons in care.
POC Due Date: 03/17/2023
Plan of Correction
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Licensee shall email the LPA a statement describing why it is important to keep the infants' crib free from loose articles by March 17, 2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2023


LIC809 (FAS) - (06/04)
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