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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423669
Report Date: 05/15/2024
Date Signed: 05/15/2024 02:37:20 PM

Document Has Been Signed on 05/15/2024 02:37 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:COOPER, ELIZABETHFACILITY NUMBER:
013423669
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: DATE:
05/15/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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 On 5/15/2024 Licensing Program Analyst Dealia Frison and Cherie Acosta conducted a unannounced increase in capacity inspection. LPA's met with Elizabeth Cooper. Licensee has an approved fire clearance for 14 children dated 4/5/24. There was 1 infant, 1 school aged child and 5 preschool aged children in care during the inspection. This family childcare home operates Monday - Friday 8:00am to 5:30pm.

LPA toured the home with licensee, to conduct a health and safety inspection. The home is a 2 story home, and consists of 3 bedrooms, 2 bathrooms, living room, kitchen, dining area. LPA observed that the home is neat and clean with heating and ventilation for the safety and comfort of children in care. The on-limit areas include living room, dining room, bath room, kitchen and rear bedroom. The remainder of the home is off limits and are made inaccessible by closed and/or locked doors, gates, and visual supervision. The rear bedroom is used for isolation of sick children, away from other children in care. The fireplace in the living room is blocked to prevent access by children during today’s visit. The back yard is used for outdoor play. Licensee was reminded that children are to have 100% visual supervision when playing in the back yard because it is not fully fenced. LPA observed toys, equipment and activities available for children and observed that they are in good condition during today’s visit. LPA did not observe any bodies of water, toxins, medications or hazardous items that would be accessible to children during today’s visit. The licensees stated that there are no firearms on the premises.

The home is equipped with fully charged 4A60BC fire extinguishers. Licensee has proof of current CPR/First aid certificates, which expire on 11/2024. LPA reviewed children's files, and obtained a copy of the current roster.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Dealia Frison
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: COOPER, ELIZABETH
FACILITY NUMBER: 013423669
VISIT DATE: 05/15/2024
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The Licensee obtained a signed property/owner landlord consent form LIC 9149 to care for 14 children.

Exit interview was conducted with Licensee where this report was reviewed and signatures obtained acknowledging receipt of documents. As of 5/15/2024 licensee has been approve to care for 14 children.

A NOTICE OF SITE VISIT IS ISSUED AND TO BE POSTED IN PUBLIC VIEW FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Dealia Frison
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC809 (FAS) - (06/04)
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