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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700360
Report Date: 06/08/2022
Date Signed: 06/08/2022 11:22:53 AM

Document Has Been Signed on 06/08/2022 11:22 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:SATRA, DOLLYFACILITY NUMBER:
015700360
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/08/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Dolly SatraTIME COMPLETED:
11:36 AM
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On 6/8/2022, Licensing Program Analyst (LPA) Jonathan Williams met with Applicant, Dolly Satra, for the purposes of conducting an announced prelicensing inspection. Present during today's inspection was the Applicant, the Applicant's husband, and two adult relatives who do not reside in the home. All adults living in the home (Applicant and Applicant's husband) are fingerprint cleared and associated. The home was toured to conduct a health and safety inspection.

The facility is a one-story home consisting of the following:

On-limit-areas: Living room, dining room, family room, kitchen, bathroom accessible via hallway, garage, backyard
Off-limit-areas: All three bedrooms (including master bathroom), enclosed office space located in the backyard.
Isolation area: Living room.

The interior of the home was toured at 9:00am. The facility was observed to be neat and clean at this time, with heating and ventilation for safety and comfort. All toxins, medications, hazardous materials, and cleaning compounds were observed to be made inaccessible to children at the time of this inspection. Ample play equipment and learning materials were observed to be present in the facility. Furniture accessible to children was observed to be in operable condition and free of loose, sharp, or pointed parts. Fireplace is screened.

Per Applicant statement, there are no firearms kept in the facility. Per Applicant statement, there are no pets kept in the home. Per Applicant statement, nobody smokes in the home. Applicant understands that all off limits areas of the home shall be kept inaccessible to children via barricade, locked doors, and/or visual supervision. LPA tested carbon monoxide and smoke detectors and LPA observed them to be functional. A fully-charged 2A10BC fire extinguisher was observed to be located in the home. A fully stocked first aid kit was observed to be located in the home.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2022
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: SATRA, DOLLY
FACILITY NUMBER: 015700360
VISIT DATE: 06/08/2022
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The backyard was toured at 9:35am. The backyard is fenced. The backyard was observed to be free of dangerous and age-inappropriate items and furnishings at this time. Per Applicant statement, there are no pools, ponds, hot tubs, or any other bodies of water on the facility premises at this time.

Applicant has required Preventive Health and Safety Training certificate, including lead poisoning prevention update. Applicant has current CPR/1st Aid certificate which expires on 05/2023. Mandated Reporter training certificates for Applicant are current, and expire on 6/18/2022. Applicant is reminded that the Mandated Reporter training course must be renewed before the expiration date. The facility sketch matches the home. All facility records to be maintained, including children's records, were discussed in-depth. COVID-19 prevention requirements set forth by state and county public health authorities were discussed.

Incidental Medical Services (IMS) policy was discussed. 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.

Applicant 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.



Applicant was reminded that California Law requires licensed Family Child Care Homes 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 624b). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the Applicant to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Applicant was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: SATRA, DOLLY
FACILITY NUMBER: 015700360
VISIT DATE: 06/08/2022
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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-and-resources/safe-sleep as an additional resource. LPA also informed Licensee 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 Applicant is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Applicant was informed that any area of the home marked "off-limits" must be inspected by the department before being placed "on-limits".

This home is recommended for a license for a small Family Child Care Home effective 6/8/2022.

Appeal Rights provided. Exit interview conducted at 11:20am
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
LIC809 (FAS) - (06/04)
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