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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409281
Report Date: 06/16/2022
Date Signed: 06/16/2022 12:26:59 PM

Document Has Been Signed on 06/16/2022 12:26 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:DUMONT, DULCINEAFACILITY NUMBER:
073409281
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/16/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Dulcinea Dumont TIME COMPLETED:
12:30 PM
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On 06/16/2022 at 9:00 AM, Licensing Program Analysts (LPAs), Christina Watts and Monica Mathur conducted an announced Pre-licensing Inspection at Dulcinea Dumont's home and met with Applicant, Dulcinea Dumont who has applied for a Small Family Child Care Home with a capacity of eight (8). Days and hours of operation will be Monday – Friday from 7:30 AM - 5:30 PM, Weekends (only twice a month) 10 AM - 7 PM. Living in the home are Applicant, her spouse and two children (ages 5 and 3).

Applicant completed 8-hour Preventative Health & Safety training, Nutrition and Lead Poisoning training, 8 hour Pediatric CPR & First Aid which expires 12/2023, has documentation for Measles, Pertussis, and Influenza for current season. Applicant and adults living in the home have Criminal Record and Child Abuse Index Clearance and documentation for Tuberculosis (TB) clearance. Applicant owns the home. LPA reminded that when care for more than six and up to eight is provided, Applicant must notify parents. Applicant plans to get insurance once licensed. Applicant has a working telephone in the home.

Three story Home comprises LEVEL 1, LEVEL 2, LEVEL 3 with 2 bedrooms, 2 1/2 bathrooms, Kitchen, Hallway, Living/Dining room on Level 2, Play Room/Living room on Level 1, Office, attached Garage, and Large Backyard
Areas to be used for day care: LEVEL 1 Living room, LEVEL 2 Living room and front entrance to be used to pickup/drop off by parents and children. Children will arrive at the front door, enter Level 2 and assisted to walk down the steps leading to the Level 1 Play Room (Living room).
Off-Limit Areas: LEVEL 3 master bedroom and master bathroom, kids bedroom, 1 bathroom, office and closet. LEVEL 2 Kitchen, Deck. LEVEL 1 Garage
Isolation Area: Little nook area in Level 1 day care room
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2022
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: DUMONT, DULCINEA
FACILITY NUMBER: 073409281
VISIT DATE: 06/16/2022
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LPA toured the indoor space of the home. It is sanitary and orderly, with heating and ventilation for safety and comfort. There are stairs in the home which are gated. LPA observed fully charged 2A10BC fire extinguisher, working smoke, carbon monoxide detector. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets with latches and locks. LPA reminded that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Applicant states there no arms and ammunition stored in the home.

Outdoor Space: LPA toured the outdoor areas. Children will be using right side portion of backyard only. Rest of the yard is off limit and inaccessible with child gate/fences and low hedges. Entrance and exit from backyard would be from Level 1 play area. Applicant has a deck on second floor that will not be used by children in care. There is a vegetable garden in the middle of the yard and several fruit trees. The yard has fences on all sides. No bodies of water were observed. LPA observed a trampoline that applicant stated children will not use.

Discipline policy was discussed, and Applicant states she will talk to the children as form of discipline. She understands that children's personal rights should not be violated and no corporal punishment. Isolation of sick children, 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 once every six months and documented.



LPA reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.
LPA discussed and reminded Applicant day care needs to be operated within the limitations and capacity of a Small Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.

This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
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: DUMONT, DULCINEA
FACILITY NUMBER: 073409281
VISIT DATE: 06/16/2022
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LPA discussed the safe sleep regulations with Applicant, and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Website links for provider resources:


Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

This home is recommended for licensing as of 06/16/2022. Exit interview conducted and report was reviewed with the Applicant, Dulcinea Dumont .
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
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