013421192-1-8-2024-52-CC-MPRE-CZAVS3-20240108154052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421192
Report Date: 01/08/2024
Date Signed: 01/08/2024 03:41:00 PM

Document Has Been Signed on 01/08/2024 03:41 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:	TUCK, NELVA		FACILITY NUMBER:	013421192
ADMINISTRATOR:	TUCK, NELVA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 825-9925
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94542
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 7	CENSUS: 7	DATE:	01/08/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Nelva Tuck		TIME COMPLETED:	03:40 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 1/8/2024 at 1:20pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Nelva Tuck for a Required – 3 Year Inspection. Present during the inspection was the Licensee, her helper Dorotea Soto, Licensee’s sixteen (16) year old daughter (Licensee's daughter left during LPA's inspection), one (1) infant and five (5) preschool age children. One (1) school age child arrived at 2:20pm. The facility operates 7:30am – 5:30pm, Monday – Friday. ON LIMITS AREA: Entire Main Home (used for childcare): Living Room, Dining Area, Kitchen, One (1) Bedroom, Two (2) Bathrooms and Backyard OFF LIMITS AREA: Basement, home behind the main home (home Licensee lives in, consists of two (2) bedrooms, one (1) bathroom, living room and kitchen) ISOLATION AREA: Living Room The facility is single story home rented by the Licensee. The inside of the home is observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, personal medications, and hazardous materials were observed to be in inaccessible areas. Licensee stated that she provides all food for the children. All food that is brought from the children’s home will be properly labeled and stored. LPA observed child sized mats and two (2) play yards used for napping that were clean, free from defects and properly stored. All children’s bedding was observed to be clean and properly stored as well. All off limit areas are made inaccessible with locks, gates, and closed doors. Licensee stated she does not transport children. There is one (1) rabbit in the backyard in a caged pen and no firearms in the home. The home has one (1) fully charged 3A40BC fire extinguisher in the nook area by the kitchen. There is one (1) working smoke/carbon monoxide detector in dining room. The home is equipped with central heat and air for proper ventilation. Page 1 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

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: TUCK, NELVA	FACILITY NUMBER: 013421192
	VISIT DATE: 01/08/2024

NARRATIVE

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The backyard of the home is fully fenced, clean, and properly maintained. There is a wooden play structure that is anchored into the ground and well maintained. There is a slide and three swings attached to it. There is ample cushion under the swings and slide for safety. There is a large trampoline in the backyard that is not in use and one small trampoline that is used by the children. The trampoline is low to the ground and has a protective mesh netting around it for safety. LPA did not observe any harmful bodies of water in or around the home.

The facility is operating within its licensed capacity and is in ratio. Licensee’s Health and Safety training has been completed and EMSA approved Pediatric CPR & First Aid has expired as of 7/2023 (see LIC809D). LPA instructed Licensee to register for a training course by Wednesday 1/10/2024. Licensee’s Mandated Reporter training is complete and expires 11/14/2024. Fire/disaster drills have not been conducted within the last six (6) months (see LIC809D). LPA instructed Licensee to conduct a drill by Wednesday 1/10/2024 and document it. All required forms are posted and visible for view by the front door of the home. All adults living and working in the home have obtained a criminal record clearance. LPA obtained a sample of the children’s files, the facility files and the helper’s file. Through record review it was found Licensee did not have a file for one (1) child in care. All other files were complete.

Deficiencies Cited During LPA’s Inspection
· Licensee's expired EMSA approved Pediatric CPR & First Aid training
· Fire Drills not conducted within the required six (6) months

Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's parents, and to the Department within 24 hours by phone. Within seven (7) days from the incident, Licensee’s must submit the Unusual Incident/Injury form (LIC 624B) to the Department. Licensee was reminded that any structural changes or additions to the home must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

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: TUCK, NELVA	FACILITY NUMBER: 013421192
	VISIT DATE: 01/08/2024

NARRATIVE

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Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting https://mandatedreporterca.com/. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee Nelva Tuck, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

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: TUCK, NELVA	FACILITY NUMBER: 013421192
	VISIT DATE: 01/08/2024

NARRATIVE

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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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

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

Exit interview conducted and report was reviewed with the Licensee Nelva Tuck.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 01/08/2024 03:41 PM - It Cannot Be Edited

Created By: Morgan Pringle On 01/08/2024 at 02:59 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: TUCK, NELVA	FACILITY NUMBER: 013421192
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/10/2024
	Plan of Correction
1 2 3 4	Licensee has not conducted a fire/disaster drill since 3/2023. LPA instructed Licensee to conduct a drill by Wednesday, 1/10/2023. Licensee will document the drill on the fire/disaster drill log and send a copy of the log to LPA Pringle.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/10/2024
	Plan of Correction
1 2 3 4	Licensee's CPR & First Aid expired in 7/2023. LPA Pringle instructed Licensee to register for a training by Wednesday 1/10/2024 and send LPA Pringle a copy of the receipt of registration. Upon completeion of the course, Licensee will send LPA Pringle a copy of the training certificate.

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:

Jason Jang

LICENSING EVALUATOR NAME:

Morgan Pringle

LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

LIC809 (FAS) - (06/04)

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