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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409281
Report Date: 08/23/2023
Date Signed: 08/23/2023 12:25:01 PM

Document Has Been Signed on 08/23/2023 12:25 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: 12CENSUS: 6DATE:
08/23/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Dulcinea DumontTIME COMPLETED:
10:00 AM
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On 8/23/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Case Management inspection at Dulcinea Dumont's family childcare home for CAPACITY INCREASE and met with Licensee, Dulcinea. 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).

Fire Clearance was granted on 7/27/23 under conditions that Garage and Second Floor stay off limits. Licensee has met all Fire Department requirements. All licensing documents and requirements are complete. Licensee understands that parents have to be notified and Parent Notification for Additional Children in care LIC9150 has to be maintained in child files. Licensee understands the ratio requirements of large childcare home. Stairs and all off limit areas are gated.

If no Assistant is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home.



Indoor Space: Home is on 3 levels - Lower Floor, First Floor, Second Floor
Lower Floor:
On Limits: Play Room, Bathroom
Off Limits: attached Garage
First Floor:
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 area in Play room (Lower Floor)

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)
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: DUMONT, DULCINEA
FACILITY NUMBER: 073409281
VISIT DATE: 08/23/2023
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Case Management Report - page 2

Outdoor Space:

On limits: Right side of backyard which is enclosed and separated from rest of the yard. only. Entrance and exit from backyard would be from Level 1 play area.

Off Limits: Outdoor Deck on First Floor and Rest of the yard made inaccessible with gate/fences and low 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.

Facility is approved for LARGE CHILDCARE HOME. New areas are approved for use.


Exit interview was conducted with Licensee, Dulcinea Dumont. NOTICE OF SITE VISIT WAS ISSUED, MUST BE POSTED 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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