<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010215269
Report Date: 06/09/2022
Date Signed: 06/20/2022 11:26:08 AM

Document Has Been Signed on 06/20/2022 11:26 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:O'BRIEN, SUSANFACILITY NUMBER:
010215269
ADMINISTRATOR:O'BRIEN, SUSANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 581-4727
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
06/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Susan O'BrienTIME COMPLETED:
04:00 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
On June 9, 2022, at 2:00 PM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced Annual Required Inspection and met with licensee, Susan O'Brien. Present during the inspection were two (2) school age children and one (1) preschool age child. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. The facility plans to operate between the hours of 7:00 AM-6:00 PM, Monday -Friday

LPA toured the facility to conduct a Health and Safety inspection. This single story home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. The Isolation area will be a section of the living room, away from other children in care.

On-limit-areas are the: Living room, hallway bathroom, dining room, kitchen, play room, bathroom next to the playroom, and laundry room

Off-limit-areas are : Entire back yard area which is inaccessible by a gate, closed and/or locked doors and visual supervision

There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. There are ample age appropriate toys that appear to be safe and in good condition. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection.

The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, first aid kit, and telephone. The fireplace is blocked to prevent access by children and there are no heaters accessible to children in care. Per licensee, there are firearms in the home. LPA verified that the firearms are stored properly.

The outdoor play area is the front yard and the licensee is reminded to have 100% visual supervision when outdoors since it's unfenced. The licensee is in compliance with the immunization laws which pertains to all childcare providers. All required forms are posted and visible for public review.

See 809-C for continuance
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 6