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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010212181
Report Date: 10/25/2023
Date Signed: 10/25/2023 01:57:18 PM


Document Has Been Signed on 10/25/2023 01:57 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:JARAMILLO, ROSAFACILITY NUMBER:
010212181
ADMINISTRATOR:JARAMILLO, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 701-7047
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY:12CENSUS: 2DATE:
10/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Rosa JaramilloTIME COMPLETED:
02:10 PM
NARRATIVE
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On Wednesday, October 25th, at 9:40AM Licensing Program Analyst (LPA) Brittany Crass and Licensing Program Manager (LPM) Loretta Dyson arrived at the home for an unannounced Required - 1 year inspection. LPA met with Rosa Jaramillo. There were 2 preschool aged children in care when we arrived, and 2 more preschool aged children arrived during the inspection. This family childcare home operates Monday - Friday 8am-5pm. LPA verified that the licensee's phone number and email address on file are correct.

LPA toured the on-limits area of the home to conduct a health and safety inspection. The home is a 2 story home, and consists of 3 bedrooms, two playrooms, 3 bathrooms, living room, kitchen, dining area, backyard and outdoor art room. LPA observed that the home has heating and ventilation for the safety and comfort of children in care. The on-limit areas include two playrooms downstairs, backyard and downstairs bathroom. The off-limit areas include the entire upstairs, the downstairs bedroom, and the outside art room. These areas are made inaccessible by closed and/or locked doors, gates, and visual supervision. A seat at a table in the playroom is used for isolation of sick children, away from other children in care, and next to an air purifier. The backyard is used for outdoor play and is fully fenced. LPA did not observe any hazards or dangerous conditions in the yard. LPA observed an ample supply of age-appropriate toys, equipment and activities available for children both indoors and outdoors and observed that they are in good condition. The licensee has 6 chickens, 2 dogs, a fish, and a cat. LPA did not observe any bodies of water, toxins, or hazardous items that would be accessible to children. The licensee stated that there are no firearms on the premises.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Brittany CrassTELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 9


Document Has Been Signed on 10/25/2023 01:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: JARAMILLO, ROSA
FACILITY NUMBER: 010212181

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that she has not conducted or recorded a fire drill every 6 months, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2023
Plan of Correction
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Licensee will conduct a drill, and then email licensing a copy of the record by 11/22/23. Licensee will continue to conduct and document drills every 6 months going forward.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Brittany CrassTELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/25/2023 01:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: JARAMILLO, ROSA
FACILITY NUMBER: 010212181

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that the licensee did not have proof of immunization for measles during todays inspections, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2023
Plan of Correction
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Licensee will obtain either a record of measles immunization, or have a blood test done to show immunity against measles, and will send in proof to licensing by 11/22/23.
Section Cited
Deficient Practice Statement
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POC Due Date: 10/25/2023
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Brittany CrassTELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023
LIC809 (FAS) - (06/04)
Page: 3 of 9


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: JARAMILLO, ROSA
FACILITY NUMBER: 010212181
VISIT DATE: 10/25/2023
NARRATIVE
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The home is equipped with fully charged 2A10BC fire extinguisher, a working combination carbon monoxide/smoke detector, working telephone, and a first aid kit. Licensee has proof of current CPR/First aid certificates, which expire on 7/2025. The fire drill log was not available. LPA observed all of the required forms posted. LPA reviewed 2 children's files, and obtained a copy of the current roster. LPA obtained proof of immunization for pertussis (TDaP), and a statement declining the flu vaccination for the licensee. She did not have proof of immunization for measles (MMR).

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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.

LPA reminded the licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. LPA provided the main office number for the Oakland Regional Child Care office (510) 622-2602 for the licensees to call and report injuries or unusual incidents and reviewed the form to follow up in writing within 7 days of the injury/unusual incident. The licensees were encouraged to periodically review regulations, guidelines and Provider Information Notices (PINs) on the website www.ccld.ca.gov.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Brittany CrassTELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC809 (FAS) - (06/04)
Page: 8 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: JARAMILLO, ROSA
FACILITY NUMBER: 010212181
VISIT DATE: 10/25/2023
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA reminded the licensee that the mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com. Licensees mandated reporter expires on 6/24/2024.

A notice of site visit was given and must remain posted for 30 days.

Appeal rights were given. See LIC809-D for deficiencies given today.

Exit interview conducted and report was reviewed with the licensee.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Brittany CrassTELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC809 (FAS) - (06/04)
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