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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423689
Report Date: 09/06/2022
Date Signed: 09/06/2022 02:26:46 PM

Document Has Been Signed on 09/06/2022 02:26 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:JAFFE, MARTINA & ALEXANDER-TANNER, ELIFACILITY NUMBER:
013423689
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
09/06/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:TIME COMPLETED:
02:30 PM
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On 09/06/2022 Licensing Program Analyst (LPA) Arminder Singh met with Licensee, Eli Alexander-Tanner and Martina Jaffe for an announced Capacity Increase inspection. There are 3 children present today. Days and hours of operation are Monday thru Friday 8:30 AM to 4:30 PM.

The home is a single story home. The home consists of a living room, kitchen, three bedrooms, two bathrooms, laundry room, backyard, and shed that is located in the backyard.

On limits area: The bedroom located towards the back of the home, the bathroom which is also located towards the back of the home, and the backyard.

Off Limit Area: The remainder of the home will be off limits which will be made inaccessible by use of closed and/or locked doors, gates and visual supervision.

Isolation Area: Left corner of the on limit bedroom.

Outdoor Play Area: Back Yard is fully fenced. LPA reminded that 100% visual supervision is required when children are playing outside. The Licensee has a gate on top and bottom of the stairs of the patio which leads to the backyard. The shed located in backyard is made inaccessible by lock.


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SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: JAFFE, MARTINA & ALEXANDER-TANNER, ELI
FACILITY NUMBER: 013423689
VISIT DATE: 09/06/2022
NARRATIVE
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The home is sanitary, safe and orderly, with central heating and ventilation for safety and comfort. LPA observed required Postings on the wall. LPA observed: fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detectors all over the home. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets and out of reach of children. LPA reminded Licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. Licensee states there are no pets in the home. Licensee states there are no firearms and ammunition stored in the home.

The Licensee's both have current CPR and First Aid certification and expire on 12/2023. The Licensees conduct and document fire and earthquake drills at least twice a year. Last fire drill was conducted on 06/16/2022. LPA reminded Licensee that the mandated reporter training certificates are to be renewed every two years.

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
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: JAFFE, MARTINA & ALEXANDER-TANNER, ELI
FACILITY NUMBER: 013423689
VISIT DATE: 09/06/2022
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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.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensees 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.

The Home is Recommended for Capacity Increase effective 09/06/2022.



Exit Interview was conducted, where this report was reviewed and discussed with Licensee. Report was signed by the Licensee confirming receipt of documents.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

END OF REPORT
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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