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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423464
Report Date: 06/16/2023
Date Signed: 06/16/2023 12:48:41 PM

Document Has Been Signed on 06/16/2023 12:48 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:FORD, CASSANDRAFACILITY NUMBER:
013423464
ADMINISTRATOR:FORD, CASSANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(570) 885-1179
CITY:BERKELEYSTATE: CAZIP CODE:
94708
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
06/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:23 AM
MET WITH:Cassandra FordTIME COMPLETED:
12:59 PM
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On June 16, 2023 at approximately 9:23am Licensing Program Analyst (LPA) Indira Loza met with Licensee Cassandra Ford to conduct a Required 1-year annual inspection. Present for today’s inspection were the Licensee, the Licensee's Husband, two assistants and 7 children. The facility is in ratio today. Hours of operation are Monday - Friday 8:30am to 5:00pm.

The facility is a two story home with the upper level consisting of 4 bedrooms; three bathrooms; a living room, dining room, and kitchen. The lower level consists of a mudroom, a half bathroom, a den, a garage, and a large backyard.

ON LIMIT AREAS: The mudroom, half bathroom, den, and half of the backyard.


OFF LIMIT AREAS: The entire second floor, the second half of the backyard with a swimming pool (which has a locked fence surrounding the pool), and the garage. The off-limit areas will be inaccessible by child gates, closed and/or locked doors and adult supervision.
ISOLATION AREA: Is either in the den or outside, depending on where the additional daycare children are, the sick child will always be waiting with an adult until picked up.

The home has heating and ventilation for safety and comfort. The home has a fully charged 3A40BC fire extinguisher, smoke and carbon monoxide detectors, and a working telephone. Fire drills are conducted at least once every 6 months, the last drill was completed on February 15, 2023. Licensee has ample age-appropriate toys and learning materials inside and outside the home. Toxins, medicines, and hazardous items were inaccessible during today's inspection. The Licensee has utilized the backyard for outdoor play. LPA reviewed six children's files and four staff files which were found to be complete. The facility roster was reviewed, and a copy obtained. The Licensee has Liability insurance. Per Licensee there are no firearms in the home.

***********************************Report Continues on LIC 809-C*******************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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: FORD, CASSANDRA
FACILITY NUMBER: 013423464
VISIT DATE: 06/16/2023
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Mandated Reporter and First Aid certificates for the Licensee and Assistants were current. Licensee was reminded that CPR/1st Aide and Mandated Reporter is to be renewed every two years.


Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02. 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

Licensee was reminded that all adults 18 and over living or working in the home, 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 discussed the safe sleep regulations with licensee 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 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to [email protected]. 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.

There were no deficiencies cited during today's visit.

Exit interview conducted and report was reviewed with the Licensee Cassandra Ford.

Report and Appeal Rights were provided.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC809 (FAS) - (06/04)
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