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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409261
Report Date: 03/30/2022
Date Signed: 03/30/2022 02:24:07 PM

Document Has Been Signed on 03/30/2022 02:24 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:PHILLIPS, MEESHAFACILITY NUMBER:
073409261
ADMINISTRATOR:PHILLIPS, MEESHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 617-9790
CITY:HERCULESSTATE: CAZIP CODE:
94547
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/30/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Meesha PhillipsTIME COMPLETED:
03:00 PM
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On 3/30/2022 at 1:00 PM Licensing Program Analysts (LPAs) A. Curry and C. Watts arrived at the home and conducted an announced relocation prelicensing inspection. LPA met with applicant, Meesha Phillips, who submitted an application for a large Family Child Care Home. The hours of operation for the family child care home will be Monday-Friday 6:00am-6:00pm. A tour of the home was completed with the applicant to conduct a health and safety inspection.

The home is two-story and consist of 4 bedrooms, 3 bathrooms, living room, kitchen, dining area, laundry room, fenced backyard, and garage. The children will use the downstairs bathroom, living room, kitchen, dining area, and backyard. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. The off-limits areas are the garage, downstairs bedroom, and the entire upstairs, which consist of 3 bedrooms, 2 bathrooms, and laundry room. The off-limit areas will be inaccessible by closed and/or locked doors and visual supervision. The Isolation area will be in the kitchen away from the other children. The applicant stated that she will use the backyard for outdoor play. LPA reminded the applicant to have 100% visual supervision of children while in the backyard due to the accessible air conditioner unit. The applicant was advised that any area that will be changed to an on limit area will need to be inspected by Licensing prior to use. There were safe toys, play equipment, and materials observed for children. LPA did not observe any bodies of water, toxins, medications or hazardous items that would be accessible to children. The applicant was advised that all poisons and/or hazardous items must be kept in a locked cabinet/drawer or placed out of reach of children. There is a safety gate at the bottom of the stairs to prevent access by children and the home is equipped with central heating. The applicant stated there are no firearms on the premises.



The home is equipped with a fully charged 2A10BC fire extinguisher, working smoke alarm, working carbon monoxide detector, telephone, and first aid supplies. The applicant has current CPR and First Aid training which expires on February 08, 2024 respectively.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2022
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: PHILLIPS, MEESHA
FACILITY NUMBER: 073409261
VISIT DATE: 03/30/2022
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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.

The applicant is reminded of the following: to review and follow COVID-19 guidelines, to report any injuries or unusual incidents, including COVID-19 exposures and positive results at the facility. The applicant is advised to review licensing regulations and guidelines, including the Provider Information Notices (PINs) on the website www.ccld.ca.gov and to sign up to receive quarterly updates by email by sending a request to [email protected].

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

Licensee 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 verified that the applicant has a criminal record clearance and is associated to the license. Licensee was reminded of the responsibility as a mandated reporter. The licensee was reminded that the mandated reporter training needs to be renewed every 2 years, at www.mandatedreporterca.com.

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.


This home will not be licensed today pending manager's approval. An exit interview was conducted with Meesha Phillips. This report will remain on file for 3 years. A copy of the appeal rights were provided.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC809 (FAS) - (06/04)
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