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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423379
Report Date: 06/06/2023
Date Signed: 06/06/2023 12:02:53 PM

Document Has Been Signed on 06/06/2023 12:02 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:CANNON, JANETFACILITY NUMBER:
013423379
ADMINISTRATOR:CANNON, JANETFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 847-8883
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
06/06/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:08 AM
MET WITH:Janet CannonTIME COMPLETED:
01:03 PM
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Licensing Program Analyst Sidney Cortez, met with licensee Janet Cannon for an UNANNOUNCED ANNUAL RANDOM INSPECTION. Present for this visit was the licensee Janet Cannon, and 2 of her fingerprint cleared assistants Sherie Martinez, and Sonia Cannon, along with her fingerprint cleared husband Richard Cannon. Present are 3 infants and 2 preschool age children .The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 8:00 am – 5:30 pm, Monday thru Friday.The home consists of the living room, dining area, kitchen, two bedrooms and one bathroom, and the detached garage, which has been converted into a child care room and includes a second bathroom.


The on limit areas include the living room, dining area,bathroom in the hallway, the converted garage, and bathroom in the garage. The kitchen will be used to walk thru to the garage and backyard, with supervision. The off limit area is the first bedroom on right, the master bedroom and kitchen, which are made inaccessible by gate, closed and/or locked doors and visual supervision. The isolation area will be a section of the living room, away from other children in care. The fenced backyard will be used for outdoor play. The lower section of the yard will be the on limits area, and the upper areas of the yard will be off limits for now. There are ample age appropriate toys that are safe and appear to be clean and in good repair. There are no pools, hot tubs or any other bodies of water.

LPA did not observe any hazardous materials or toxins accessible to children today. The home has a fully charged (3A40BC) fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The licensee CPR and First Aid certificate is current and expires September (2024). The licensee's mandated reporter training is complete and she received a certification of completion and will expire in August 2024. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on June 2023. 2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: CANNON, JANET
FACILITY NUMBER: 013423379
VISIT DATE: 06/06/2023
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LPA Cortez provided a copy of Safe Sleep in Child Care brochure, a handout "What Does A Safe Sleep Environment Look Like?," and PIN 19-06-CCP to the licensee. LPA Cortez provided licensee with a copy of the CDSS handout on Effects of Lead Exposure and Never Shake a Baby Brochure (attached PUB 271)
The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.
The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.
Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the 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. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov
For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list



There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC809 (FAS) - (06/04)
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