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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700387
Report Date: 05/20/2024
Date Signed: 05/20/2024 03:45:33 PM

Document Has Been Signed on 05/20/2024 03:45 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 SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BORJON, BRENDAFACILITY NUMBER:
015700387
ADMINISTRATOR/
DIRECTOR:		BORJON, BRENDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 921-0251
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
05/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Brenda BorjonTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 5/20/2024 at 1:00PM Licensing Program Analyst (LPA) Jaleesa Jackson met with Licensee Brenda Borjon for an Unannounced Annual/Random visit. Also present during the inspection were her fingerprint cleared assistant, 2 infants, and 9 preschool aged children. Licensee lives in the home with her husband. The Licensee's home was toured for a health and safety inspection. The facility operates from 7:00AM – 5:00PM, Monday – Friday.

ON LIMITS AREA: Living Room, Dining Area, Kitchen, 1st Bedroom on the left side of the Hallway, Bathroom and Backyard


OFF LIMITS AREA: 2nd Bedroom on the left side of the Hallway, Bedroom at end of Hallway, Garage, the sides of the backyard
ISOLATION AREA: 1st Bedroom on the left

The facility is a single-story home rented by the Licensee. The home consists of three bedrooms, one bathroom. During today's inspection all toxins, cleaning products, medications and hazardous materials were observed to be in inaccessible areas. All off limit areas in the home are made inaccessible with closed doors and locks. There is a wall heater in the hallway that has been barricaded and is no harm to the children. LPA did not observe any harmful bodies of water in or around the home. Licensee stated that she does not transport children. Licensee provides all food for the children. All food that is brought from the children's home will be properly labeled and stored.

The back yard is fully fenced with ample age-appropriate materials for the children. There are 4 sheds that are locked and made inaccessible to the children. All sheds are used for storage. There are two play structures that are in proper working order and well maintained. The right side of the backyard is fenced off and made inaccessible to the children in care. Licensee stated that they do own two dogs that are in an off limits area. Licensee stated that no one smokes in the home and there are no firearms in the home.
Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2024
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 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BORJON, BRENDA
FACILITY NUMBER: 015700387
VISIT DATE: 05/20/2024
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There is a 2A10BC fire extinguisher in the dining area. There are working smoke/carbon monoxide detectors in the facility. LPA reviewed 11 children's files and found they are all complete. The Licensee's Pediatric CPR and First Aid certificates are current and expires on 05/2025. Mandated Reporter is current and expires 5/7/2025. The facility conducts and documents disaster drills the last disaster drill was conducted on 2/07/2024. Licensee was reminded if her assistant is not present the home should operated as a small family child care home.

There were no deficiencies cited on today's visit.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with licensee 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 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.

Continued on 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024
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 SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BORJON, BRENDA
FACILITY NUMBER: 015700387
VISIT DATE: 05/20/2024
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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: https://www.ada.gov/resources/child-care-centers/.

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

During the exit interview, the LICENSEE Brenda Borjon, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Brenda Borjon.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024
LIC809 (FAS) - (06/04)
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