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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408526
Report Date: 06/23/2021
Date Signed: 06/23/2021 11:30:46 AM

Document Has Been Signed on 06/23/2021 11:30 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:NEIRA, NIMBERLIFACILITY NUMBER:
073408526
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
06/23/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Nimberly NeiraTIME COMPLETED:
12:00 PM
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On 06/23/2021, Licensing Program Analyst (LPA), Diana Campos conducted an in-person case management/increase in capacity inspection. Present during today's inspection were licensee, and 6 children in care. Licensee's elderly mother is visiting and was also present during today's inspection. The entire home was toured to conduct a health and safety inspection with licensee. Hours of operation for day care are Monday through Friday, 6:30am to 5:30pm.

Community Care Licensing (CCL) has received an approved fire clearance.

This is a single story home. Which consists of a living room, kitchen, dining/family room, three bedrooms, two bathrooms, and attached garage. The areas used for day care are the living room, kitchen (only as walkway to dining room and back yard), dining/family room, both bathrooms, and the back yard except gated deck to the left of the house. Off limit areas will be made inaccessible by use of gates, closed and/or locked doors and visual supervision. The fenced backyard will be used as the outdoor play area. The home has an attached garage and a storage shed, which are locked. There are age appropriate toys in the home. There are no firearms in the home as stated by the licensee. LPA did not observe any hazardous materials or toxins accessible to children today.
The home has a fully charged 3 A-40-BC fire extinguisher. The home is equipped with working smoke detectors and carbon monoxide detector. There is a working telephone in the home. The applicant’s CPR and First Aid certificate is current and expires 5/15/2023. Licensee completed mandated reporter training. Licensee is in compliance with immunization requirements.

----------------------------------------------------------------------------See 809-C for continuance.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2021
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: NEIRA, NIMBERLI
FACILITY NUMBER: 073408526
VISIT DATE: 06/23/2021
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Safety precaution in regards to COVID-19 were discussed and posters were posted on front door.

The licensee was reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. The applicant was reminded of the responsibility as a mandated reporter.

Incidental Medical Services (IMS) policy was discussed.

Safe Sleep Regulations were discussed and a copy of the Individual Sleep Plan was provided.

No deficiencies observed at this visit. The licensee is now approved for a increase in capacity to operate as a large family day care home. A Notice of Site visit was given and licensee was reminded that it is required to be posted for 30 days.

Exit interview conducted, appeal rights provided, and a copy of this report was left with licensee Nimberly Neira.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
LIC809 (FAS) - (06/04)
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