Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407517
Report Date: 02/24/2017
Date Signed 02/27/2017 12:38:47 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:MCKINNEY, LESLIEFACILITY NUMBER:
073407517
ADMINISTRATOR:MCKINNEY, LESLIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 516-6361
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:14CENSUS: 4DATE:
02/24/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Leslie McKinneyTIME COMPLETED:
02:15 PM
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Licensing Program Analyst Chandra Charles met with licensee Leslie McKinney for an UNANNOUNCED ANNUAL / RANDOM visit. Present for this visit was her fingerprint cleared mother-in-law Paula Vandygriff, Assistant Ashley Dixon, 2 infants and 2 preschoolers. The home was toured to conduct a Health and Safety Inspection.
The home is neat and clean with central heating and ventilation for safety and comfort. The ON LIMIT AREAS are: the main playroom (living / dining room), part of the kitchen (where the table area is located), and the bathroom in the hallway. The OFF LIMIT AREAS are the licensee (3) children bedrooms, (1) master bedroom, master bathroom, garage, kitchen area (where the stove, cabinets and appliances are located) and the left and right side of the backyard which will be inaccessible by barrier gates, closed and/or locked doors and visual supervision. The backyard is completed fenced. The backyard is divided into three sections; the center portion of the backyard is free from defects or dangerous conditions. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water on the premises. Left side of the backyard is the BBQ pit area which is off limits. Right side of backyard is the deck area which is off limits to the day care children. Both sections are inaccessible by gates. The licensee has three dogs, two cats, eight chickens and two bunnies which are located in the center portion of the backyard.
The home has a fully charged 3A40BC fire extinguisher, pull down fire alarm device, working smoke detector, working carbon monoxide detector, working telephone, and first aid supplies. The licensee CPR and First Aid certificate is current and will expire in 08/2018. Licensee is in compliance with the new immunization laws pertaining to day care providers. Fireplace in the playroom is screened to prevent access by children. Per licensee, there are no firearms in the home. (3) Children's files were reviewed and are in compliance with the Title 22 regulations. Licensee is in compliance with the New Immunization law pertaining to day care providers.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Chandra CharlesTELEPHONE: 510-725-7529
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2017
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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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: MCKINNEY, LESLIE
FACILITY NUMBER: 073407517
VISIT DATE: 02/24/2017
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

There are no children currently on any type of medication.


Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov.

LPA showed the Licensee the New CCLD website and the You Tube tutorial videos.

There are no deficiencies cited today

An exit interview was conducted. A notice of site visit was posted. LPA advised licensee of the requirement to post the notice of site visit for 30 days and applicable penalty should the notice be removed prior to the 30 days elapsing.

This report must be available for public review for 3 years.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Chandra CharlesTELEPHONE: 510-725-7529
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2017
LIC809 (FAS) - (06/04)
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