073409372-1-18-2023-02-CC-THAR-CN7TKZ-20230118134847

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409372
Report Date: 01/18/2023
Date Signed: 01/18/2023 01:49:04 PM

Document Has Been Signed on 01/18/2023 01:49 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:	DOBOUE, MARIE		FACILITY NUMBER:	073409372
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	01/18/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	MARIE DOBOUE		TIME COMPLETED:	02:00 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	11:45AM Licensing Program Analyst Alexander met today with Marie Doboue for a ANNOUNCED RE-LOCATION INSPECTION. Applicant and her 11 year old son are present for the inspection. The home is a two story apartment consisting of 2 bedrooms, 2 bathrooms, living room/dinning room, laundry area, kitchen, and patio. The living room/dinning area, down stairs bathroom and patio will be used as the primary areas for day care. The off limits areas will be the entire upstairs which includes the 2 bedrooms and 1 bathroom, and the laundry area which is located down stairs in the dinning room area. These areas will be inaccessible to children in care by closed and/or locked doors, visual supervision and a safety gate at the bottom of the stairs. Applicant rents the apartment; proof was shown. Per applicant there are no firearms/weapons located on the premises. There is a fully charged 2A10BC fire extinguisher in the home. There is a working smoke alarm/ carbon monoxide combo that has been tested and is in working condition; recommended periodic servicing. There is a swimming pool located on the apartment complex premises that has a 5 foot fence that meets California State Fire Marshall Standards. All sharp knives, cleaning solutions and medications are inaccessible to children in care and are located in the kitchen in a high locked cabinet and shelf, and also the locked laundry area. The home has a complete First Aid Kit. The isolation area for sick children will be a corner in the dinning room area. Outdoor play will be on the patio which is fully fenced (4 1/2 foot fence). There are toys and play space available. Applicant was instructed to conduct and document periodic fire and disaster drills. Applicant was informed that baby walkers, exersaucers and baby bouncers are not allowed. Applicant has completed CPR and first aid training which expires in 1/2024 respectively. Applicant has completed her 15 hours of health and safety training which included the 1 hour of Nutrition. Applicant is scheduled to take the 1 hour of Lead poisoning training on 1/20/23. DURING TODAY'S PRE-LICENSING INSPECTION THE RESOURCE MATERIALS FOR COVID-19 WERE ALSO DISCUSSED TO HELP THE FACILITY STAY SAFE DURING THIS PANDEMIC. All forms can be downloaded at www.ccld.ca.gov. www.myccl.gov for day-care updates.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

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: DOBOUE, MARIE	FACILITY NUMBER: 073409372
	VISIT DATE: 01/18/2023

NARRATIVE

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Mandated reporter and appeal rights were discussed. Licensing forms were reviewed and copies given to applicant. Applicant was reminded 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.
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 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

As a result of today's visit, the following needs to be corrected before a license can be issued.

1. Proof of 1 hour of Lead Poisoning Training

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC809 (FAS) - (06/04)

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