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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418921
Report Date: 05/11/2021
Date Signed: 05/11/2021 01:27:57 PM

Document Has Been Signed on 05/11/2021 01:27 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:KANBERGS, CHRISTINEFACILITY NUMBER:
013418921
ADMINISTRATOR:KANBERGS, CHRISTINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 521-7132
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
05/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Karen Cabalbag-FullenTIME COMPLETED:
01:45 PM
NARRATIVE
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On 5/11/21 at 10 am, Licensing Program Manager (LPM) Loretta Dyson and Licensing Program Analyst (LPA) Lakeisha Chew arrived for a case management inspection. LPM and LPA met with Karen Cabalbag-Fullen. There were 6 children and 2 additional fingerprint cleared adults present.

LPM and LPA spoke with Karen Cabalbag-Fullen about information obtained regarding the operation of the family child care home, indicating that a child in care has been left in the child care area alone on several occasions. The licensee has also stated that the child’s parent is aware of this and has agreed to the arrangement. The licensee stated that the child is left for short periods of time, and that there is a fingerprint cleared adult in the cottage in the backyard while the child is in the main house where child care is provided. The cottage is an off limit area for the child care. LPM and LPA observed that the area of the child care where the child is usually alone is not in a position that would allow for supervision from the cottage.

See 809D for deficiency being cited today. This report will remain on file for 3 years. A notice of site visit was posted and the licensee's representative was reminded that it needs to remain posted for 30 days. A copy of the appeal rights were provided and reviewed. An exit interview was conducted.

The licensee's representative acknowledges that upon receipt of a Type A Deficiency, the licensee shall post the licensing report with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/ guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept with each child’s file as a receipt whenever any Type A documents are provided by the licensee. A copy of the LIC 9224 was given to licensee's representative at time of this inspection.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2021
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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Document Has Been Signed on 05/11/2021 01:27 PM - It Cannot Be Edited


Created By: Loretta Dyson On 05/11/2021 at 10:55 AM
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: KANBERGS, CHRISTINE
FACILITY NUMBER: 013418921

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/12/2021
Section Cited
CCR
102417(a)

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102417(a) Operation of a Family Child Care Home- The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence.
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The plan of correction was discussed and developed with the licensee's representative in her absence. By close of business on 5/12/21, the licensee will need to watch the Supervising Children in Family Child Care video on Licensing’s website, www.ccld.ca.gov. The licensee will provide a written statement
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This requirement has not been met as evidenced by information obtained confirming that a child in care has been left in the child care alone, on several occasions. This poses an immediate risk to the health and safety of children in care.
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of her understanding of, and agreement to abide by, the regulations regarding Operation of a Family Child Care Home.
Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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:Diane Perez
LICENSING EVALUATOR NAME:Loretta Dyson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2021


LIC809 (FAS) - (06/04)
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