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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423996
Report Date: 11/04/2024
Date Signed: 11/04/2024 04:46:52 PM

Document Has Been Signed on 11/04/2024 04:46 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:JOHNSON III, JOHNNYFACILITY NUMBER:
013423996
ADMINISTRATOR/
DIRECTOR:		JOHNNY JOHNSON IIIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 466-2327
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/04/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:Johnny Johnson IIITIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 11/4/2024 at 2:20 PM, Licensing Program Analyst (LPA) Janai McClain arrived at the facility for an announced prelicensing inspection. LPA met with applicant Johnny Johnson III. The applicant lives in the home with his fingerprint cleared spouse and two minor children. The applicant plans to operate Monday-Friday 7:45am-5:30pm.

LPA toured the home with the applicant to conduct a health and safety inspection. This one story home consists of two bedrooms, two bathrooms, and a detached garage, it is neat and clean with heating and ventilation for the safety and comfort of children.

The On Limit Areas are the living room, play room, kitchen, dining room, laundry, bathroom in laundry room, and fully fenced backyard.

The Off Limit Areas are the detached garage, right side of the backyard, all bedrooms, and the remaining bathroom. The off limits areas are made inaccessible by gate, closed and/or locked doors and visual supervision.

Isolation Area - couch in living room.

Inside the home the LPA observed an ample supply of age appropriate toys, activities and equipment for children, which appeared to be safe and in good condition. LPA did not observe any medication, hazardous items or poisons accessible to children during the inspection today. There are two empty water tables in the backyard. The applicant is reminded to empty the water tables daily when in use.

The home has a fully charged 3A40BC fire extinguisher, working combination smoke and carbon monoxide detector, and working telephone. The applicant's CPR and First Aid training certificate expires on 8/25. The applicant's mandated reporter training expires 2/8/2026. The applicant provided proof of control of property. **************************************Page 1 of 3****************************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: JOHNSON III, JOHNNY
FACILITY NUMBER: 013423996
VISIT DATE: 11/04/2024
NARRATIVE
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The applicant has completed the EMSA approved health and safety training. LPA reviewed all of the forms required for the children's files, facility file, posting and other information related to Licensing and the care of children. LPA left copies with the applicant. LPA advised the applicant of where to obtain additional copies of the forms. LPA reminded the applicant that the required documents must be visible for the public at all times during hours of operation. A copy of the Entrance Checklist (LIC126) was provided to the applicant.

LPA reviewed children's personal rights and reminded the applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. LPA reviewed fire/earthquake drill information, and how to complete the drill log. LPA demonstrated how to fill out the immunization record for children's files, discussed the applicant' responsibility to ensure the records are up to date and have discussions with parents/guardians if they are not, and advised that it does not need to be done if children are enrolled in school. LPA reminded the applicant to report any injuries requiring medical attention or unusual incidents to the Oakland Regional Child Care office. LPA reviewed the form to follow up in writing within 7 days of the injury/unusual incident. The applicant was encouraged to periodically review regulations, guidelines and PINS on the website www.ccld.ca.gov.

LPA verified that the applicant, and all other adults living in the home, have a criminal record clearance and are associated to the license. The applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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
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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: JOHNSON III, JOHNNY
FACILITY NUMBER: 013423996
VISIT DATE: 11/04/2024
NARRATIVE
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LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed applicant 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.

On November 4, 2024 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

The applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

On 10/11/24, a fire clearance was granted to facility by Oakland Fire Department. Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, licensee will comply with the capacity requirements for a small family child care home.



Effective 11/4/2024 the home has been approved to operate as a large family day care home.

Exit interview conducted. Report reviewed and provided to Applicant Johnny Johnson III.
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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3