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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409248
Report Date: 01/25/2022
Date Signed: 01/25/2022 01:12:16 PM

Document Has Been Signed on 01/25/2022 01:12 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:MINOR, ARTEMIS, BURGESS, DEBRA & GRIMES, ARTHURFACILITY NUMBER:
073409248
ADMINISTRATOR:MINOR, ARTEMISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 472-7320
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
01/25/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Artemis Minor and Debra BurgessTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (Phyllis) Lisa Dyer conducted an announced pre-licensing inspection due to a location change. Present were Applicants A. Minor and D. Burgess, and 5 preschoolers. The home was toured and consists of 3 bedrooms, 2 bathrooms, living room, dining room, garage and kitchen. Applicants will be utilizing the living room, dining room, 1 bedroom and 1 bathroom for her day care area. Off limits areas are 2 bedrooms, 1 bathroom, the garage and the kitchen. These areas will be inaccessible by closed and/or locked doors; gates and visual supervision.

At 11:05 a.m., the following was observed: Isolation area for sick children will be in the living room. There are no toxins accessible today. There is central heating, with vents on the floor. Knives are inaccessible to children. There is a 2-A:10-B:C fully charged fire extinguisher, a working smoke detector (tested), thermometer, carbon monoxide detector (tested) and a first aid kit. There are toys and play space available. Children will sleep on cots or mats. Per applicant, there are no firearms on the premises. Fireplace is blocked and screened. Applicant has a cell phone and a home phone. Backyard is securely fenced. There does not appear to be any dangerous hazards in the backyard such as poisons or toxins. There is a grassy area, and an area for gardening. Hot tub in the backyard is empty. It has locks on the side, and a weighted block on top so that it cannot be opened by children. Children will also play in the front yard. No pets. There are 3 fingerprint cleared adults that live in the home. The applicants are renting the property, and verification was viewed.

Training: Applicant Grimes has completed all required training. Applicant Minor and Applicant Burgess will complete CPR/First Aid Training on 1/29/22, and the Lead Poisoning Prevention Component on 1/25/22.

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 (continued)
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2022
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: MINOR, ARTEMIS, BURGESS, DEBRA & GRIMES, ARTHUR
FACILITY NUMBER: 073409248
VISIT DATE: 01/25/2022
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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.

Licensing forms were provided and reviewed to maintain facility and children's files; and to post in public area. Applicant was instructed to conduct and document periodic fire and disaster drills. Discipline methods were discussed. Applicant was instructed that spanking is not allowed. Proposed hours of operation: 6:30 am - 5:30 pm. The handout, "A Child Care Provider's Guide to Safe Sleep" was provided and discussed, along with Individual Infant Sleeping Plan requirements. Applicant was informed that all persons 18 years of age or older who frequently visit, work or reside in the home shall be fingerprint cleared prior to being in the presence of day care children. Also discussed: children in parked vehicles; training videos; changes to the facility; fingerprinting/association; smoking, and advertisements. Applicant was reminded that Mandated Child Abuse Training, as well as First Aid/CPR training is required to be completed every 2 years.

Applicant was given Title 22 regulations, and reminded that licensing updates and forms can be located on our website: www.ccld.ca.gov. For CCL Updates, go to www.ccld.ca.gov. Click the "Receive Important Updates" box. Enter your e-mail address for the Child Care Advocate Program.

Websites:
Community Care Licensing: https://www.cdss.ca.gov
Guardian Background Check: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

The applicant was requested to complete the following items prior to the issuance of a license:
1. Lead Poisoning Class for D. Burgess and A. Minor (scheduled for 1/25/22). 2. CPR/First Aid Class for D. Burgess and A. Minor (scheduled for 1/29/22). 3. Place lock on outside shed.

Applicant states that items will be completed within 10 calendar days. (Additional information may be requested.) Exit interview conducted. Applicant was given appeal rights.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022
LIC809 (FAS) - (06/04)
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