073409703-9-25-2024-02-CC-THAR-D9FPGD-20240925111810

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409703
Report Date: 09/25/2024
Date Signed: 09/25/2024 11:18:23 AM

Document Has Been Signed on 09/25/2024 11:18 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	DOBOUE, MARIE		FACILITY NUMBER:	073409703
ADMINISTRATOR/ DIRECTOR:	MARIE DOBOUE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 228-2614
CITY:	CONCORD	STATE: CA	ZIP CODE:	94520
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	09/25/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	MARIE DOBOUE		TIME VISIT/ INSPECTION COMPLETED:	11:30 AM

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On September 25, 2024, Licensing Program Analyst (LPA) Tasha Alexander met with applicant Marie Doboue for the purpose of conducting an ANNOUNCED RE-LOCATION inspection. Living in the home is the applicant, and her minor son, age 12 years old. Present in the home for today’s inspection was the applicant, and her son. The hours of operation will be Monday - Friday, 7:30 AM to 5:00PM. Age range birth to 15 years old.

The facility is a 3 bedroom, 2 bathroom one story home rented by the applicant and contains a living room, dining area, kitchen, three bedrooms, 2 bathrooms and a rear yard. The home is neat and clean with heating and ventilation for safety and comfort. Per the applicant, the ISOLATION AREA will be in the on-limits children's play room away from the other children in care, until the parents pick up.

On-limit-areas include: Living room, dining area, both bathrooms, 3rd bedroom on the right hand side as you enter the home, kitchen and backyard. Applicant was reminded that other than wipes or things used for the children in the bathrooms, they need to be empty of most all items (or locked up) such as cleaning products. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits areas.

Off-limit-areas include: The two remaining bedrooms in the home, the applicant's bedroom and her son's bedroom.

The off-limit areas will be inaccessible by closed and/or locked doors, child gates and/or by adult supervision.

Applicant has obtained liability insurance. Ratios were discussed and a copy left for applicant as a reminder. Per applicant, there are no firearms in the home.

SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: DOBOUE, MARIE	FACILITY NUMBER: 073409703
	VISIT DATE: 09/25/2024

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The home has a working smoke alarm/carbon monoxide detector combo, telephone, first aid kit, and a fully charged 2A10BC fire extinguisher which meets standards established by the State Fire Marshal.

A copy of the rental agreement was reviewed and shows control of property. The applicant completed and received a certificate in mandated reporter training on 01/9/2024. Licensee's CPR and First Aid certificate is current and expires 12/28/2025. Outdoor play will be in the fully fenced backyard. LPA did not observe any bodies of water around the home.

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: http://www.ada.gov/childqanda.htm

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.

LPA discussed the safe sleep regulations with applicant, and discussed the Child Care Licensing Safe Sleep webpage 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

SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: DOBOUE, MARIE	FACILITY NUMBER: 073409703
	VISIT DATE: 09/25/2024

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The 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.

LPA informed the applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The applicant was also reminded that Mandated Reporter Training is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

Roster of the children must be properly maintained and fire/disaster drill every six months must be documented. The applicant is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

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. Applicant reminded to have the parent board with required documents at the entry of the home and/or where the parent enter.

Entrance Checklist was provided to the applicant.

Exit interview conducted and report was reviewed with the applicant, Marie Doboue. Appeal rights provided.

The following needs to be completed before a license can be issued:

1. The wall heater located in the living room needs to be screened.

SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

LIC809 (FAS) - (06/04)

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