013418936-11-3-2021-52-CC-KPHN-C8EUR4-20211103154808

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418936
Report Date: 11/03/2021
Date Signed: 11/03/2021 03:48:18 PM

Document Has Been Signed on 11/03/2021 03:48 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	BERRIOS, CLAUDIA		FACILITY NUMBER:	013418936
ADMINISTRATOR:	BERRIOS, CLAUDIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 245-9893
CITY:	LIVERMORE	STATE: CA	ZIP CODE:	94550
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	11/03/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Claudia Berrios		TIME COMPLETED:	03:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 11/3/2021 approximately 1:05pm Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced required inspection, and met with Licensee Claudia Berrios. Present for this inspection was two infants and fingerprinted and associated helper, Lilian Garrido. Also residing in the home is the licensee's fingerprinted and associated husband, Hany Bortrous. The licensee's two children who are 12 and 13 years old also reside in the home. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday between 8:00AM to 6:00PM. ON LIMITS: kitchen/dining room (used for cooking meals), living room, concrete area of backyard, playroom (main area for children), and bathroom #1 OFF LIMITS: 3 bedrooms, bathroom #2, shed area in the backyard, and left side of the house. Off limit areas are inaccessible by closed and/or locked doors, and full visual supervision. The home is single story, which is neat and clean, with heating and ventilation for safety and comfort. A child safety gate is not required at the stairway as the Licensee has a glass door to keep children in the play room area. There were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. The home had a fully charged 3A40BC fire extinguisher and dual carbon monoxide with smoke detectors. The home has a fireplace but is closed off and not seen by children. Per licensee, there are no firearms but has a small dog in the home. The home has a large jacuzzi that is completely covered with a locked lid. The infant cribs were also accessed and advised that no toys or additional items can be inside while baby is sleeping. All baby materials have labels and has an accessible sink for changing babies. SEE LIC 809 C *

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

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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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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: BERRIOS, CLAUDIA	FACILITY NUMBER: 013418936
	VISIT DATE: 11/03/2021

NARRATIVE

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The backyard area was also observed and accessed. The outdoor grill area has locked cabinets and all appliances that are turned off. LPA advised licensee to provide a gate around the outdoor air conditioning to prevent any harm to children. Licensee also advised LPA that she has not used the backyard space since she only cares for two infants but will open it up once she has more children in care. LPA advised licensee to report any changes to on-limit and off-limit areas to the Department.

The licensee conducts and documents fire drill log that was conducted on 9/14/21. All required licensing documents are posted and visible for public review. At 1:30pm, children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. The licensee has required mandated reporter training that is completed as of 9/22/2021. CPR and First Aid training are also updated as of 9/21/2021. LPA reminded licensee to have all immunizations and records up to date and to send proof of immunizations and informed licensee about sleeping log/plan to be corrected by tomorrow 11/4/2021.

Exit interview conducted. Appeal rights and site visit was given to licensee to post for 30 days.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. Facility is following IMS plan on file. When any changes to the IMS plan is made, an updated 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.”

See LIC 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: BERRIOS, CLAUDIA	FACILITY NUMBER: 013418936
	VISIT DATE: 11/03/2021

NARRATIVE

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There's no deficiencies during today's inspections.

Facility Representative was reminded that all adults 18 and over, 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 Child Care Center. 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.

Facility Representative was reminded that California Law requires licensed Child Care Centers 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 by phone, fax, or electronic mail. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Facility Representative 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.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

LIC809 (FAS) - (06/04)

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