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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423379
Report Date: 05/09/2022
Date Signed: 05/09/2022 11:43:39 AM

Document Has Been Signed on 05/09/2022 11:43 AM - 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:CANNON, JANETFACILITY NUMBER:
013423379
ADMINISTRATOR:CANNON, JANETFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 847-8883
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/09/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Janet CannonTIME COMPLETED:
11:50 AM
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On May 05, 2022, at 10:15AM, Licensing Program Analyst (LPA) Catherine Fernandes met with Licensee Janet Cannon for an announced inspection to put the License on Active Status. Residing in the home is the Licensee, her two underage daughters, finger print cleared husband and her adult brother. The Licensee, her adult brother and two children were present for the inspection. The home was inspected to conduct a Health and Safety check. Operating hours will be between 8am - 5:30pm Monday through Friday.

This home is a single story house with two bedrooms and two bathrooms which was neat and clean for the children. The OFF LIMIT AREAS will be both bedrooms, the bathroom in the main house, the top area of the yard, the yard area on the left side of the house and the crawl space under the house, which will be inaccessible by gate, closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the kitchen, the living room and the two lower levels of the yard, the converted garage that will be used as an additional activity space and the bathroom in the in the converted room. The ISOLATION AREA will be the couch in the living room. The outdoor play area is broken into three levels (top level is off limit) that is fenced in with toys available for the children. There are ample age appropriate toys that are observed to be safe, clean and in good repair. There are no bodies of water or pools accessible to children in care during todays inspection.

The home has a fully charged 3A40BC fire extinguisher in the converted garage, working smoke detector, carbon monoxide detector both located in the kitchen and a working telephone. There's a pull down fire alarm in the converted play area. The applicant’s Health and Safety training was completed. Per licensee, there are no firearms in the home. The licensee was reminded in order to continue to be licensed she must reside in the home and that there can be no napping or eating in the converted play area.

The Licensee was reminded that ALL assistants, volunteers, frequent visitors, or adults living in the
Report continues on 809C.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2022
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: CANNON, JANET
FACILITY NUMBER: 013423379
VISIT DATE: 05/09/2022
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home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. The applicant was reminded of the responsibility as a mandated reporter. The licensee needs to provide proof of the required training for all people caring for children.

Individual 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

The licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

For licensing updates email childcareadvocatesprogram@dss.ca.gov to be added to the email list.

The following needs to be completed before the license can be put on active status:
- All people caring for children must complete mandated reporter training
- LIC 508 for all living and caring for children
- Immunization, TB and flu for adult brother and anyone caring for children
- all cleaning products in the bathroom need to be inaccessible to children in care
- kitchen cabinets containing cleaning products and knives need to be latched
- gate for the stairs in the backyard
- Licensee needs to complete Mandated reporter and CPR training


Exit Interview conducted with Licensee
Appeal Rights and Report provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
LIC809 (FAS) - (06/04)
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