073409281-8-23-2023-02-CC-MMAR-CUYQSX-20230823122615

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409281
Report Date: 08/23/2023
Date Signed: 08/23/2023 12:26:22 PM

Document Has Been Signed on 08/23/2023 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, DULCINEA		FACILITY NUMBER:	073409281
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	08/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Dulcinea Dumont		TIME COMPLETED:	01:00 PM

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On 8/23/23 Licensing Program Analyst (LPA) Monica Mathur conducted an Unannounced Required Inspection at Dulcinea Dumont's Family Child Care Home. LPA met with Licensee, Dulcinea Dumont and explained the purpose of today’s inspection. Present in the home were Licensee, Assistant and 6 children (1 infant, 5 preschool age). Other adults present in the home were Licensee's spouse. Licensee's father and mother-in-law (on temporary visit).

Indoor Space: Home is on 3 levels - Lower Floor, First Floor, Second Floor
Lower Floor (downstairs):
On Limits: Play Room, Bathroom
Off Limits: attached Garage
First Floor (entrance level):
On Limits: Play Area added for use; it is separated from Dining Nook by furniture, gate and curtains. Front entrance area - children drop off/pick up is at the front door.
Off Limits: Kitchen, Dining nook, Family room, Outdoor deck
Second Floor: completely off limits
Isolation Area: Little nook in Play room (Lower Floor)

Outdoor Space:

On limits: Right side of backyard which is enclosed and separated from rest of the yard. Entrance and exit for play area is from Play Room at Lower Floor.

Off Limits: Outdoor Deck on First Floor and Rest of the yard made inaccessible with gate/fences, planters and hedges. There is a locked storage shed, vegetable garden beds in the middle of the off limit yard and several fruit trees. The entire yard has fences on all sides. No bodies of water were observed. LPA observed a trampoline that children will not use.

continued on 809-C

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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: 08/23/2023

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809-C page 2
LPA observed sufficient materials, toys, and play equipment. Children were engaged in various activities under the supervision of the Licensee and Assistant. All detergents, cleaning compounds, medications, and other similar items were inaccessible to children. Furniture and equipment were age appropriate and in good condition. There were no baby walkers, jumpers observed during inspection. The home is sanitary, orderly and safe. There is screened fireplace in the Lower Floor Play Room and gated stairs in the home. LPA observed a fully charged fire extinguisher that meets State Fire Marshal standards and working smoke/carbon monoxide detectors. There are no pets in the home. LPA reviewed a current Children Roster, Emergency Disaster Plan LIC610A. Last fire/disaster drill was completed in May 2023. All required postings were observed posted on a wall. Licensee states she does not transport children. She provides snacks and children bring their own lunch. Food storage area was observed to be sanitary.

FILE REVIEW: Children, Licensee, Assistant files were reviewed. Licensee’s Mandated Reporter Training is current (expires 12/23) and CPR/First Aid is current (expires 12/23 ). Assistant file is missing MMR and Mandated Reporter training.

Supervision of children was discussed, and Licensee understands that she must be present in the home during 80% of the operating hours and ensure children are supervised at all times.

Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

On 7/14/23 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.
continued on 809-C

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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: 08/23/2023

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809-C page 3
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the Safe Sleep regulations with Licensee and the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep
as an additional resource. LPA also informed Licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.
continued on 809-C

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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: 08/23/2023

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809-C page 4
To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

At 11:45 pm Licensee's school age child arrived, making the number of children present at 7 (1 infant, 5 preschool, 1 school age).

In the areas that were evaluated, no regulatory violations were observed. Technical Violations were issued for MMR and Mandated Reporter Training.

Exit interview conducted and report was reviewed with the Licensee. During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A Notice of Site Visit was given to Licensee, Dulcinea Dumont and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC809 (FAS) - (06/04)

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