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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423360
Report Date: 07/22/2022
Date Signed: 07/22/2022 06:59:29 PM

Document Has Been Signed on 07/22/2022 06:59 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:BROWN, DRENAFACILITY NUMBER:
013423360
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
07/22/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Drena BrownTIME COMPLETED:
04:00 PM
NARRATIVE
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On 07/22/22 at 2:00 PM, Licensing Program Analyst (LPA), Christina Watts conducted a Case Management Inspection (Change of Capacity) at Drena Brown's family day care home and met with Licensee, Drena Brown. LPA explained the purpose of today's inspection. Licensee currently is licensed as a Small Family Child Care Home with a capacity of eight (8). During today's inspection, there were 6 children in care (2 infants and 4 preschool children) Residing in the home: Licensee, licensee adult son who is an aid, and licensee 3 minor children under the age of 18 years old. Adult son is fingerprint cleared. Licensee completed her Pediatric CPR/First Aid which expires 09/2022. LPA reminded licensee to update her CPR/First certificate. Licensee stated she will update CPR/First Aid certificate the first week of August. Licensee has documentation maintained for Measles, Pertussis Immunization's, Influenza Opt-Out statement for the current flu season. There is a working telephone in the home. Fire clearance request was approved 01/20/2022 by Oakland Fire Department.
INDOOR SPACE: LPA inspected the indoor space of the home. This is a split level home with the entrance located on the mid level part of the home. The home consists of 4 bedrooms, 3 bathrooms, dining/living room, kitchen, and back yard. The home is sanitary, safe and orderly, with heating and ventilation for safety and comfort.
IN-USE AREAS: Living/Dining Room, 3rd floor hall bathroom
OFF LIMIT AREAS: Second floor bedrooms, master bedroom and master bath, lower level bedroom, laundry room.

LPA observed infant child in crib in an off limit area. Licensee stated she informed licensing regarding the use of the off limit area. LPA informed licensee licensing has to inspect area before off limit area can be in use for children in care. LPA observed a wood burning fireplace in the living room however it's covered by wood board as well book shelf in front of fireplace. The fireplace is made inaccessible for children in care.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2022
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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Document Has Been Signed on 07/22/2022 06:59 PM - It Cannot Be Edited


Created By: Christina Watts On 07/22/2022 at 05:36 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: BROWN, DRENA
FACILITY NUMBER: 013423360

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2022
Section Cited
CCR
102416.3(a)(2)

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102416.3(a)Prior to making alterations or additions to a family child care home...the licensee shall notify the Department of the proposed changed...(2)Room additions to the family child care home.
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By 07/25/2022, Licensee agreed to submit a written statement acknowledging her understanding of the regulation and ensure she is in compliance moving forward.
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This requirement is not met as evidenced by: observed child in crib in an off limits bedorom. This poses a potential risk to the health and safety of children.
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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Christina Watts
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022


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: BROWN, DRENA
FACILITY NUMBER: 013423360
VISIT DATE: 07/22/2022
NARRATIVE
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LPA observed 2 fully charged 2A10BC fire extinguisher, working smoke and carbon monoxide detector. Medicines, cleaning products, sharp objects are stored inaccessible to children. Access kitchen is made inaccessible to children in care. LPA reminded that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. Stairs to the second level have child gates on the bottom of stairs. Per licensee, there are no weapons or firearms in the home.

OUTDOOR SPACE: Outdoor space is currently off limits for children in care. Licensee stated she used backyard for outdoor play space for children in care. LPA informed licensee licensing has to inspect area before off limit area can be in use for children in care. LPA inspected the backyard and observed anchored swing set as well as age appropriate toys for children to play with. There are two entrance to backyard. LPA suggested to use right side of entrance. LPA discussed with licensee that there needs to be 100% supervision when children are playing in the backyard.



LPA discussed and reminded Applicant day care needs to be operated within the limitations and capacity of a Large Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours. All documents have been reviewed for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.
For licensing updates, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

In the areas that were evaluated, there were 1 deficiency observed.

Effective as of 07/22/ 2022, the 2nd floor bedroom (nursery) and backyard are approved for IN USE for children in care. Licensee Drena Brown capacity increase application is pending until licensing received plan of correction.

Notice of Site visit was given. At 6:30 PM Exit interview was conducted with Licensee Drena and she signed the report acknowledging receipts of documents.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
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