010216105-8-27-2021-52-CC-JWIS-C6ASCS-20210827134600

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010216105
Report Date: 08/27/2021
Date Signed: 08/27/2021 01:46:06 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	JUBILADO, TERESA		FACILITY NUMBER:	010216105
ADMINISTRATOR:	JUBILADO, TERESA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 790-2724
CITY:	FREMONT	STATE: CA	ZIP CODE:	94555
CAPACITY:	14	CENSUS: 2	DATE:	08/27/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Teresa Jubilado		TIME COMPLETED:	01:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 08/27/2021 at 12:45pm, Licensing Program Analyst (LPA) Jonathan Williams met with Teresa Jubilado for a Required 1 Year Inspection. Present for this inspection are the Licensee, the Licensee's fingerprint cleared and associated adult daughter, and two children in care (one infant and one preschooler). Operating hours are 7:00am-5:30pm M-F. The facility was toured to conduct a health and safety inspection. The home is a 2-story home and is tidy and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are dining room, play room, front room, downstairs bathroom, and backyard. The OFF LIMIT AREAS are the kitchen, garage, and entire second floor, all of which will be made inaccessible to children by closed and/or locked doors, barricade, and visual supervision. The ISOLATION ROOM is dining room. The interior of the home was toured at 12:45pm. There are toys and learning materials in the facility. All hazardous materials and toxins were observed to be made inaccessible to children during today's inspection. Per Licensee, there are no firearms kept in the home. There is a fireplace in the home which is screened to prevent access to children. Toilets and sinks were found to be in operable condition. LPA observed adequate amounts of paper towels and hand soap available to children in the bathroom during today's inspection. No cleaning supplies were observed to be accessible to children during today's inspection. LPA toured the outdoor play area at 12:58pm. All play equipment was observed to be operable and age-appropriate during this inspection. Cushioning material (lawn) is present to absorb falls. Uncontaminated drinking water is available to children in the outdoor area. There are no pools, hot tubs, ponds, or any other bodies of water in the on-limits areas during today's inspection.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: JUBILADO, TERESA	FACILITY NUMBER: 010216105
	VISIT DATE: 08/27/2021

NARRATIVE

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The facility has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Licensee has current CPR/1st Aid training which expires on 1/4/2022. Mandated Reporter Training for Licensee expires on 12/19/2021. Mandated Reporter Training for Licensee's daughter expires 1/4/2022. The facility is in ratio today. Children's files were reviewed for proper documentation. Facility roster was obtained.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS to children in care. 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 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 that California Law requires licensed Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624b). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the Licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

There are no deficiencies cited. A Notice of Site Visit was provided to the Licensee. LPA reminded the Licensee to post the Notice of Site Visit where it is clearly visible inside the facility for 30 days. Appeal rights were provided to the Licensee. Exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

LIC809 (FAS) - (06/04)

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