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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418519
Report Date: 02/06/2020
Date Signed: 02/06/2020 02:40:49 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:PALASTI, ADRIENNE EFACILITY NUMBER:
013418519
ADMINISTRATOR:PALASTI, ADRIENNE EFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 427-2351
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY:14CENSUS: 14DATE:
02/06/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:Kristal RecosanaTIME COMPLETED:
03:10 PM
NARRATIVE
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On 02/06/20 at 1:08pm, Licensing Program Analysts Briana Plumboy and Manel Estoesta met with a finger print clear Assistant Provider Kristal Recosana for an UNANNOUNCED RANDOM INSPECTION. Present for this visit was 3 infant, 10 preschoolers, and a fingerprint clear assistants Alyssa Hardman. At 1:43pm, assistant Marilene Saia arrived at the facility with 1 school age child. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 7:30am until 6:00pm.
The home is single story. The home has heating and ventilation for safety and comfort. The ON LIMIT AREAS are the living room, kitchen/dining room combination, the 2 bathrooms, the 1st room on the right upon entrance, and the room located next to the bathroom. The OFF LIMIT AREAS are the laundry room and the bedroom located next to the kitchen which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the bedroom located next to the bathroom. The FRONTYARD play area is completely fenced. There is also a side yard connected to the front yard with a separate fence and canopy shade. There are toys and learning materials. There are no pools, hot tubs or any other bodies of water present in the on limit areas. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible during today's inspection.
The home has a fully charged 2A10BC fire extinguisher, smoke detector, carbon monoxide detector, first aide kit, and working telephone. Assistant Marilene DaCunha has a valid CPR/First Aid certificate which expires 03/09/21, assistant Alyssa Hardman's expires 10/2019, and . The licensee Adrienne Palasti and her assistants are in compliance with the immunization law which pertains to providers. The licensee received a certificate in mandated reporting on 07/01/18, Alyssa received her certificate on 01/22/19, Kristal recieved her certificate on 01/17/19, and Marilene received her certificate on 01/28/19. There is a wall heater which is screened to prevent access by children and located inside the living room. Per assistant Kristal, there are no firearms in the home to her knowledge. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 01/23/20. The facility is out of ratio today and has 1 child enrolled as a preschooler or infant too many in her count. This was observed upon entry at 1:08pm. All REQUIRED forms are posted and visible for public review. See 809-C and 809-D for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
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: PALASTI, ADRIENNE E
FACILITY NUMBER: 013418519
VISIT DATE: 02/06/2020
NARRATIVE
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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

LPA Plumboy provided a copy of Safe Sleep in Child Care brochure, a handout "What Does A Safe Sleep Environment Look Like?," and PIN 19-06-CCP to the licensee
LPA Plumboy provided licensee with a copy of the CDSS handout on Effects of Lead Exposure

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

Effective August 1, 2003 California Law requires 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. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

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

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list



See 809D for deficiency. The attached Type A deficiency is cited today. Upon receipt, licensee shall post for 30 days and provide copies of this licensing report to parent/guardians of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 Acknowledgement of Receipt of Licensing Reports should be signed by guardians and placed in each child’s file. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
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: PALASTI, ADRIENNE E
FACILITY NUMBER: 013418519
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/07/2020
Section Cited

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102416.5(a) Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided.
THE FACILITY IS OUT OF RATIO TODAY. WHEN LPAS ARRIVED AT THE FACILITY, PRESENT WAS
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2 ASSISTANTS AND 13 CHILDREN ENROLLED WHO ARE NOT SCHOOL AGE CHILDREN. LPA PLUMBOY DISCUSSED THE AGE REQUIREMENTS TO STAY IN COMPLIANCE WITH RATIO. WHEN A FACILTY IS OUT OF RATIO, THIS POSES AN IMMEDIATE RISK TO CHILDREN IN CARE.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2020
LIC809 (FAS) - (06/04)
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