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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409146
Report Date: 04/20/2021
Date Signed: 04/20/2021 10:30:18 AM

Document Has Been Signed on 04/20/2021 10:30 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:PASQUINI, PAULAFACILITY NUMBER:
073409146
ADMINISTRATOR:PASQUINI, PAULAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 599-2517
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/20/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Paula PasquiniTIME COMPLETED:
10:35 AM
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On April 20, 2021, Licensing Program Analyst (LPA), Melissa Guirit and LPA Melissa Domantay, met with applicant Paula Pasquini for an ANNOUNCED PRE LICENSING INSPECTION. Present for this inspection was applicant and finger print cleared Landlord D. Arana. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are 8-5 M-F.

The home is a two story home. The home consists one kitchen, 3 bedrooms, 2 bathrooms, front living room, "dining area" used for childcare, back living room "day care classroom", and backyard. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the entire front half of the home, which includes two bedrooms, one bathroom, living room, and kitchen, garage, upstairs bedroom in the back. The main entrance is off limits. Off limit areas which will be inaccessible by closed and/or locked doors, baby gates, and visual supervision. The ON LIMIT AREAS are dining area "used for childcare", one bathroom located in the back of the home, back living room "day care classroom", backyard. The entrance to the day care is through the left side gate. The ISOLATION AREA will be back living room "day care area". Outdoor play area will be in the backyard which is completely fenced and requires visual supervision at all times. The outdoor play area is free from defects or dangerous conditions. There is an ample supply of toys and activities available for children, and they are in good condition and age appropriate. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today.

See 809-C for continuos
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2021
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: PASQUINI, PAULA
FACILITY NUMBER: 073409146
VISIT DATE: 04/20/2021
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The home has a fully charged 3A40 BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and fully stock First Aid Kit. The applicant’s Health and Safety training is completed, lead poisoning training is completed, and CPR and First Aid certificate is current and expires 11/7/2022. Applicant completed the Mandated Reporter Training which expires on 3/2023. The applicant is in compliance with new immunization law which pertains to day care providers. Per applicant, there are no firearms in the home. A copy of the lease agreement was reviewed and shows control of property. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. Applicant was sent the Covid-19 self assessment, applicant has completed the assessment and emailed form to LPA Guirit

Applicant is 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. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov .http://www.myccl.gov/

Incidental Medical Services (IMS) policy was discussed. 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


This home is recommended for licensing as of April 20, 2021. This report shall remain on file for 3 years. Exit interview conducted with applicant. A copy of this report and appeal rights will be emailed to the Applicant.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021
LIC809 (FAS) - (06/04)
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