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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420280
Report Date: 10/20/2022
Date Signed: 10/20/2022 12:00:55 PM

Document Has Been Signed on 10/20/2022 12:00 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:WILLIAMS, FRANKIE & ROBERTFACILITY NUMBER:
013420280
ADMINISTRATOR:WILLIAMS, FRANKIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 536-6398
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
10/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Robert WilliamsTIME COMPLETED:
12:10 PM
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On October 20, 2022 at approximately 9:00am Licensing Program Analysts (LPA) Russ Haderer and Lorraine Dacanay-Breaux arrived unannounced for an annual inspection for health and safety. Present for the inspection was co-licensees Robert and Frankie Williams and 5 children in care (3 infants, 2 two-year olds). The facility is in ratio today. The hours of operation remain at 6:30 am to 6:00pm.

The facility is a 2 bedroom, 2 bath single family home with a front and back yard area, no garage. There is a fireplace in the living room that has a screen also blocked with a bookcase.

ISOLATION AREA will be in the living room away from other children in care until their parents can come and pick them up.

On-limit-areas include: Living room, dining room, kitchen; front bedroom and house bathroom, and fenced backyard area. Licensees reminded that other than wipes or things used for the children in the on limits bathroom, they need to be empty of most all items (or locked up) such as cleaning products etc. The kitchen has appropriate latches for safety mounted on all cupboards within the children's reach. There were no hazardous items in any drawers or cupboards.

Off-limit-areas include: Back bedroom and back bathroom. The off-limit areas will be inaccessible by closed and/or locked doors.

There is a fully charged 2A10BC fire extinguisher mounted on the living room wall. The facility has a working (tested) smoke and carbon monoxide detectors. Per licensee, there are no firearms in the home. The licensee conducts and Fire/Disaster Drills but has not been keeping a log to document them.

Required licensing documents are posted and visible. Licensee owns the home and has childcare liability insurance through Hays Companies Inc – Assure Child Care effective 10/13/2022 through 10/13/2023.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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: WILLIAMS, FRANKIE & ROBERT
FACILITY NUMBER: 013420280
VISIT DATE: 10/20/2022
NARRATIVE
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There were ample age appropriate toys that were observed to be safe and in good condition. The home is neat and clean, with heating and ventilation for safety and comfort. LPAs did not observe any hazardous materials, or toxins accessible to children on the premises during the inspection.

Children's files were reviewed, the facility roster was reviewed and a copy obtained. Children’s files were missing the LIC700 Emergency Information form (emergency phone numbers for parents were written on top of health history forms and physician’s name and contact details on the children’s roster). Files were missing LIC627 Consent for Emergency Medical Treatment form for all children’s file, see LIC809D for deficiency.

Both licensee’s Pediatric CPR/First Aid certificate are current and expire on 7/18/2023. Both licensee’s Mandated reporter training was completed 10/22/2021. Licensee, and all adults living in the home are in compliance with immunization laws which pertains to day care providers. LPAs reminded the licensees that CPR/1st Aid and Mandated Reporter training is to be renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

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.

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 (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

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.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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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: WILLIAMS, FRANKIE & ROBERT
FACILITY NUMBER: 013420280
VISIT DATE: 10/20/2022
NARRATIVE
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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/inspection-process.

There was 1 deficiency issued today (see LIC809D for deficiency):


Missing LIC627 Consent for Emergency Medical Service.

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

Exit interview conducted and report was reviewed with the licensees Robert and Frankie Williams.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/20/2022 12:00 PM - It Cannot Be Edited


Created By: Russell Haderer On 10/20/2022 at 11:23 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: WILLIAMS, FRANKIE & ROBERT

FACILITY NUMBER: 013420280

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 10/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)

An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that all children's files did not contain LIC627 form consent for medical treatment which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2022
Plan of Correction
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Licensee will collect parent's signed LIC627 Consent for Medical Treatment forms. Going forward, all children's files will have these completed, signed and dated forms.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2022


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