Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070209920
Report Date: 07/28/2017
Date Signed 07/28/2017 02:02:43 PM

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:SRVSACCA - KIDS COUNTRY-BOLLINGER CANYONFACILITY NUMBER:
070209920
ADMINISTRATOR:NG, CELINAFACILITY TYPE:
840
ADDRESS:2300 TALAVERA DRIVETELEPHONE:
(925) 552-4481
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:120CENSUS: 45DATE:
07/28/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Isabel JarvisTIME COMPLETED:
02:30 PM
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3) I, Licensing Program Analyst, Jason Jang made an unannounced annual random inspection to the facility. I met with the Assistant Director, Isabel Jarvis. All staff meet the criminal background clearance requirement. The facility had a working smoke detector, carbon monoxide detector, and fully recharged size 2A10BC fire extinguisher. All bodies of water such as pools, hot tubs, or similar bodies of water were inaccessible to children. Poisons, detergents, cleaning compounds, and medication were inaccessible to children. All children were properly supervised during the visit. The Licensee was reminded that children are not to be left alone in vehicles when on field trips. The Licensee maintains the capacity on the license. Each child has safe, comfortable, and healthful accommodations, furnishings, and equipment. Staff had a current pediatric CPR and first aid certificate. Children's files were reviewed and found to be complete including immunization requirements. Licensee provides the child’s parent or representative a copy of the Family Child Care Home Notification of Parent’s Rights. Licensee was reminded of Departments inspection authority, with our without any notice. The Licensee is conducting and documenting fire drills and utilizing the child care roster. Upon notice of the Department to remove an individual from the home or to exclude an individual from the home, the Licensee immediately removes the individual and prevents them from returning to the home or having contact with children. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The IMS policy has already been sent 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 Also discussed: nutrition education; the new appeal process; and documents to be provided to parents/legal guardians. Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates. The sudden infant death syndrome pamphlet was given to the Licensee. There were no deficiencies cited in today's visit
SUPERVISOR'S NAME: Zakiya AliTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2017
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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