073409150-5-20-2021-02-CC-CACA-C37S8T-20210520133941

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409150
Report Date: 05/20/2021
Date Signed: 05/20/2021 01:39:49 PM

Document Has Been Signed on 05/20/2021 01:39 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:	BERRY, SYDNE		FACILITY NUMBER:	073409150
ADMINISTRATOR:	BERRY, SYDNE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 331-7500
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	05/20/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Sydne Berry		TIME COMPLETED:	01:45 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	Licensing Program Analyst (LPA) Cherie Acosta met with applicant Sydne Berry for an announced Prelicensing/ change in location Inspection. Also residing in the home is the licensee's adult son, Reggie Bell, and licensee's two minor children. Applicant states that the hours of operation will be 6:00am to 6:00pm Monday through Friday. The home was toured for a Health and Safety Inspection. The home is single story home. The home consists of a living room, family room, kitchen, 4 bedrooms, 2 bathrooms, laundry room, and garage The home is neat and clean with heating and ventilation for safety and comfort. The on limits area for child care will be the living room, family room, kitchen, master bedroom, and both bathrooms. The remainder of the home will be off limits to children and will be made inaccessible by use of closed and/or locked doors and visual supervision The living room will be used as the isolation area. The fenced backyard will be on limits to children. Applicant plans to use the front yard as the outdoor play area. Applicant understands that 100 percent supervision is required while children are in the front yard as the area is not fenced. There are age appropriate toys in the home. There are no pools, hot tubs or any other similar bodies of water at this home. There are no firearms in the home as stated by the applicant. LPA did not observe any hazardous materials or toxins accessible to children today. The home is equipped with a working smoke detector and carbon monoxide detector. There is a working telephone in the home. The home has a fully charged 2A10BC fire extinguisher. The fireplace is screened to prevent access by children. The applicant has current CPR/First Aid which expires 03/2023. Applicant completed mandated reporter training 4/4/20. Applicant is in compliance with required immunizations. A copy of the lease was reviewed and shows control of property. Files were reviewed with applicant. Safe sleep information was provided and discussed with the applicant. Safety precaution in regards to COVID-19 were also discussed with applicant.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2021

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 2

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: BERRY, SYDNE	FACILITY NUMBER: 073409150
	VISIT DATE: 05/20/2021

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
26
27
28
29
30
31
32

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 and for day care updates visit www.myccl.gov

Applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

Applicant was also encouraged to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

The following must be completed prior to licensure:

- the bricks around the fireplace shall be covered for the safety of children.
- the smoker located in the backyard shall be covered for the safety of children
- sprinkler hoses shall be removed from the back yard for the safety of children.

Exit interview was conducted and appeal rights were provided.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2