073409154-5-25-2021-02-CC-MSUN-C3CVE9-20210525162158

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409154
Report Date: 05/25/2021
Date Signed: 05/25/2021 04:22:11 PM

Document Has Been Signed on 05/25/2021 04:22 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:	KNEIP, MARIESSA		FACILITY NUMBER:	073409154
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS:	DATE:	05/25/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Mariessa Kneip		TIME COMPLETED:	04:30 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 5/25/2021 Licensing Program Analysts Michelle Sutton and Monica Mathur conducted an announced Pre-licensing Inspection at Mariessa Kneip home and met with Applicant, Mariessa who has applied for a Small Child Care Home with a capacity of 8 children. The home was toured to conduct a Health and Safety Inspection. The Child Care home plans to operate Monday-Friday from 7:15am-5:15pm. Living in the home there are adult tenant who is fingerprint cleared and son who is 9 years old. 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. Applicant was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov The applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Applicant completed the 16-hour Preventative Health training which includes EMSA approved CPR and first aid, one hour of Child Care Nutrition and Lead Poisoning. Applicant has documentation maintained for Measles, Pertussis Immunizations, opted out for the current flu season and Tuberculosis (TB) clearance. Applicant has Criminal Record statement and Child abuse Index Clearance. Applicant rents the home and has submitted a copy of the Rental Agreement to CCLD. LPA reminded Applicant that when care for more than six and up to eight is provided, Applicant must notify parents and obtain landlord consent. Applicant will use their own day care insurance. Applicant has a working telephone in the home.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021

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: KNEIP, MARIESSA	FACILITY NUMBER: 073409154
	VISIT DATE: 05/25/2021

NARRATIVE

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INDOOR SPACE: At 2:15pm LPAs toured the indoor space of the home. The home consists of living room, kitchen, attached garage, 4 bedrooms and 2 bathrooms. The home is in compliance with Title 22 Regulations at this time.

IN-USE AREAS: Classroom, playroom and bathroom

OFF-LIMIT AREAS: Kitchen, Living room, Bedroom 1, Bedroom 2, Bedroom 3, Master bedroom, master bathroom and garage. Outside off-limit areas is the deck, pool area, hill side and left side area with 2 sheds that are kept locked. Applicant has child proof doorknobs on all off-limit doors.

OUTDOOR SPACE: At 2:45pm LPA toured the outdoor area (backyard). LPAs observed an above ground pool with a cover on top that is secured to the ground with screw rods and child proof gate surrounding the pool. Applicant stated the the ladder to the pool is stored in the shed. LPAs discussed with applicant that there needs to be 100% supervision when children are playing with water. LPAs reminded applicant that there needs to be 100% supervision walking children through off-limits area of the kitchen and deck to get to the play area.

LPAs observed 1A10BC fire extinguisher reminded applicant there needs to be a 2A10BC or larger fire extinguisher. Working carbon monoxide detector. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets in off-limit kitchen. LPAs reminded Applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Applicant states that there are 3 cats and no fire arms and ammunition stored in the home.

At 3:30pm Discipline policy was discussed, Applicant stated she will talk to the children, positive reinforcement and if using "time-out" no longer then their age for forms of discipline. Applicant understands that children's personal rights should not be violated and no corporal punishment. Isolation of sick children will be in classroom while other children are in playroom, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries and requirements for assistant/substitute were also discussed. Fire drills must be practiced at least once every six months and documented. A Family Child Care Home packet was provided.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021

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: KNEIP, MARIESSA	FACILITY NUMBER: 073409154
	VISIT DATE: 05/25/2021

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LPA discussed Incidental Medical Services (IMS) policy. Applicant plans on providing Incidental Medical Services (IMS) at this time. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. LPA discussed Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at www.mandatedreporterca.com. AB 633 was discussed with Applicant. Licensing forms and Title 22 regulations can be obtained through the internet at www.ccld.ca.gov.

LPA discussed with Applicant, Effective August 1, 2003 California Law requires Family Child Care Home licensees 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 electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

Beginning January 1, 2019 AB2370 requires licensed family childcare homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. For Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important department information can be found on, http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates.

The following improvements to be completed prior to recieving license for a small family childcare home by 6/2/21.

1. Working smoke detector

2. Fire extinguisher
3. Lock on outside gate
4. Emergency disaster plan posted
5. Child passenger safe seat law form posted

LPA provided a Family Child Care Home packet with copies of all required forms and documents needed for starting the day care. LPA also reviewed all the forms with the Applicant. AT 4:00 PM Exit interview was conducted with Applicant and she signed the report acknowledging receipts of documents. License will be granted subject to approval with CCLD Management.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021

LIC809 (FAS) - (06/04)

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