073409126-2-6-2024-02-CC-THAR-D282S6-20240206163838

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409126
Report Date: 02/06/2024
Date Signed: 02/06/2024 04:38:49 PM

Document Has Been Signed on 02/06/2024 04:38 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:	ALLEN, MELISSA		FACILITY NUMBER:	073409126
ADMINISTRATOR:	ALLEN, MELISSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 509-4014
CITY:	MARTINEZ	STATE: CA	ZIP CODE:	94553
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	02/06/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	MELISSA ALLEN		TIME COMPLETED:	04:40 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 2/06/2024 at 1:30PM Licensing Program Analyst (LPA) Tasha Alexander met with Licensee Melissa Allen for a Required - 3-Year annual Inspection. Licensee is the only one present during the inspection. Licensee lives in the home with her husband, Johnathan Allen, and two minor children, a 8 year old son and 5 year old daughter. Licensee’s home was toured health and safety inspection. The facility operates from 8:45am – 1:15pm, Monday - Thursday. ON LIMITS AREA: hallway bathroom, kitchen, living room, dining room and child care room. OFF LIMITS AREA: All Three (3) bedrooms, master bathroom, garage and the side yard on the left side of the backyard. ISOLATION AREA: Living Room The facility is a single-story home owned by the Licensee and her husband. The inside of the home was observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. Licensee states that she provides snacks and the children bring lunch from home. All food that is brought from the children’s home is properly labeled and stored. Licensee stated that she does not transport children. There 1 small dog. There are no firearms in the home per licensee. There is one (1) fully charged 2A10BC fire extinguisher in the childcare room. There are several working smoke alarm/carbon monoxide combo detectors throughout the home. The fireplace in the living room is locked making it inaccessible to the children in care. Licensee uses age appropriate tables for eating. Licensee states that she does not care for infants. Licensee's fcch is part-time, so there is not napping equipment located in the home. The home is equipped with central heat and air.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024

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: ALLEN, MELISSA	FACILITY NUMBER: 073409126
	VISIT DATE: 02/06/2024

NARRATIVE

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The backyard is fully fenced, clean and has ample age appropriate materials for the children in care. There are storage areas in the back yard that are gated off making them inaccessible to the children. LPA did not observe any harmful bodies of water in or around the home.

Licensee is operating within their licensed capacity and is in ratio. Licensee’s Health and Safety training with Lead Poisoning component has been completed and Pediatric CPR and First Aid training is complete and expires 10/2024. Licensee’s Mandated Reporter training is complete and expires 10/27 2024. LPA obtained the fire/disaster drill log, log is complete with the last drill logged 10/2023. All adults living and working in the home have obtained a criminal record clearance. All required forms are posted in the childcare room by the entrance back door. LPA obtained the children’s files, helper's file and facility roster. All files were complete.

Licensee was reminded that California Law requires Licensee 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 624). Incidents must be reported within 24 hours by phone, fax, or email. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.
Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com

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.

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SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ALLEN, MELISSA	FACILITY NUMBER: 073409126
	VISIT DATE: 02/06/2024

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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 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. License has stated that she does not care for infants at this time.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Licensee Melissa Allen.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024

LIC809 (FAS) - (06/04)

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