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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421853
Report Date: 06/12/2024
Date Signed: 06/12/2024 01:17:57 PM

Document Has Been Signed on 06/12/2024 01:17 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MONTOYA, ROBERTFACILITY NUMBER:
013421853
ADMINISTRATOR/
DIRECTOR:		MONTOYA, ROBERTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 377-8148
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
06/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Robert MontoyaTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On June 12, 2024 at approximately 9:15am Licensing Program Analyst (LPA) Randy Miranda and Licensing Progrma Manager (LPM) Wynn Norona met with licensee Robert Montoya for the purpose of conducting an unannounced annual inspection for health and safety. Upon arrival, present were the licensee, assistant, and 11 children in care (2 infants, 10 pre school age, and 1 school age). During the inspection, LPA Miranda and LPM Norona observed 1 assistant arrived and 3 additional pre school age children. The facility is in ratio today. The hours of operation are Monday-Friday, 7:30am to 6:00pm.

The facility is a single-story home with 3 bedrooms and 1 bathroom, a living room (with a fireplace covered with a wooden gate to prevent access), a small infant area (formerly a dining room), kitchen, attached 2-car garage front, side and back yards. The facility is neat and clean with heating and ventilation for safety and comfort. The outdoor play area is large and includes a large play structure on the left side of the yard that is anchored to the ground, and many other activity areas, which are free from defects and dangerous conditions. The outdoor play area has an inside small fence to keep the northern and patio areas of the house off limits to children. There are ample age appropriate toys/activities inside and outside that were observed to be safe and in good condition. The areas used for childcare include the front living and dining areas, the rear two rooms, which are the art and nature studios, hallway bathroom, and the backyard.



On-limit-areas include: The living room, the infant sleeping area, the house bathroom, two back bedrooms (nature and art studio) side yard and backyard.

Off-limit-areas include: The kitchen, the first room on the left side of the hallway, the attached two car garage and the northern area of the backyard and the patio and the attached 2-car garage. Off limit areas are inaccessible by closed and/or locked doors and visual supervision. Toxins, medicines, and hazardous items were inaccessible during today's inspection.

Please see 809-C for continuation
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Randy Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MONTOYA, ROBERT
FACILITY NUMBER: 013421853
VISIT DATE: 06/12/2024
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There are two fully charged 2A10BC fire extinguisher located inside the garage next to the small garage door, The facility has working (tested and functioning) smoke and carbon monoxide detectors. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills at least twice a year, All required licensing documents are posted and visible for public review.

Children’s files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. All files were organized and complete. Sleeping logs for infants were in use and available for review. The licensee rents the property and supporting documents are on file.



The licensee’s and helper’s Pediatric CPR/First Aid certificate is current and expires 3/18/2025, while another assistant CPR/First Aid expires 9/23/2025. Mandated reporter training was completed (licensee on 3/29/2024, assistant #1 on 3/29/2024, assistant #2 on 2/26/2023). LPA reminded the licensee of the following: Mandated Reporter and CPR/1st Aid 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.

Please see 809-C for continuation

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Randy Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MONTOYA, ROBERT
FACILITY NUMBER: 013421853
VISIT DATE: 06/12/2024
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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.

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 were no deficiencies cited today.

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



Exit interview conducted and report was reviewed with the licensee Robert Montoya.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Randy Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC809 (FAS) - (06/04)
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