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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421394
Report Date: 09/15/2023
Date Signed: 09/15/2023 02:14:11 PM

Document Has Been Signed on 09/15/2023 02:14 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:FREE TO BE ME CHILD CAREFACILITY NUMBER:
013421394
ADMINISTRATOR:BILLINGSLEY, JANETTEFACILITY TYPE:
840
ADDRESS:1040 FLORENCE RD.TELEPHONE:
(925) 292-8377
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 65TOTAL ENROLLED CHILDREN: 65CENSUS: 23DATE:
09/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:40 AM
MET WITH:Janet BillingsleyTIME COMPLETED:
02:20 PM
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On September 15, 2023, Licensing Program Analyst (LPA) Simerjit Kaur conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION for School Age component and met with site director with Janet Billingsley. The facility was toured to conduct a Health and Safety Inspection. There were 3 staff and 23 children present during the inspection. The facility is within ratio and capacity compliance today. The facility operates Monday - Friday from 7:00am - 6:00pm.

This component operates out of classrooms Hive and Coop. There is adequate heating, ventilation and lighting. There is individual storage space for each child. There are adequate play and learning materials available. Furniture and equipment is age appropriate and in good repair. The storage areas and cabinets for poisons are locked. There are working carbon monoxide detectors in each classroom, fire extinguisher and a pull down alarm device. There are separate bathrooms for staff and the children. The bathrooms for children are located at the end of building and children should be supervised when going to bathrooms. Toilets and faucets working properly. Adequate lighting is provided in all bathrooms. All required postings are posted. The facility serves PM snacks. The menu is also posted for review. Drinking water is available inside and outside.

There are age appropriate play equipment, and materials for the school age children. The first aid kit (backpack) is available in the classroom. Sign-in and sign-out logs were reviewed to verify signatures. LPA reviewed staff file and children files. All opener and closer staff have CPR and First Aid certificates. All staff have current training and required documents in files. The facility has conducted fire/disaster drill on 9/11/23. All required forms were posted in a public accessible area. There are no bodies of water accessible to children. Per director there are no firearms on the premises. A copy of the children’s roster and facility roster was obtained.


See LIC 809 C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: FREE TO BE ME CHILD CARE
FACILITY NUMBER: 013421394
VISIT DATE: 09/15/2023
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Facility director was reminded that all adults 18 and over, 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 Child Care Center. 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.

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing information.
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.
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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/15/2023 02:14 PM - It Cannot Be Edited


Created By: Simerjit Kaur On 09/15/2023 at 01:41 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: FREE TO BE ME CHILD CARE
FACILITY NUMBER: 013421394

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

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, 2 staff members do not have completed LIC 503, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2023
Plan of Correction
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By 10/16/23, director shall provide proof of LIC 503 to LPA.
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:Jason Jang
LICENSING EVALUATOR NAME:Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2023


LIC809 (FAS) - (06/04)
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