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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422571
Report Date: 01/28/2020
Date Signed: 01/28/2020 10:22:41 AM

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:LOW, JACQUELINEFACILITY NUMBER:
013422571
ADMINISTRATOR:LOW, JACQULINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 875-5649
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:14CENSUS: 8DATE:
01/28/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:02 AM
MET WITH:Jacqueline LowTIME COMPLETED:
10:45 AM
NARRATIVE
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On 1/23/2020 at 8:02AM, Licensing Program Analyst (LPA) Junell Chen arrived for an unannounced Annual/Random Inspection, and met with Licensee Jacqueline Low. Present were three infants and five preschoolers. At 8:51AM, Licensee's fingerprint cleared assistant Maria Piceno Cortez arrived at the facility. At 9:40AM, the 7th preschool child arrived at the facility. Not present during the inspection was fingerprint cleared husband Jerry Low. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday 7:30AM - 5:30PM, and occasional Saturdays 8AM-3PM.

ON LIMITS: The living room, dining room, converted garage/play area, one bathroom, and selected portion of fenced backyard.
OFF LIMITS: The kitchen, family room, four bedrooms, and two bathrooms.

The home is a single story, which are neat and clean, with heating and ventilation for safety and comfort. The isolation area will be in the living room. There were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. Fire extinguisher, smoke detector and carbon monoxide detector meet State Fire Marshall standards. Per licensee, there exists central heating and heater vents are not hot to touch. Per licensee, there are no firearms in the home. There is a pet dog in the home. All required licensing documents are posted and visible for public review.



During the time of inspection, 7 children's files were reviewed. The facility file was reviewed. The facility roster was presented and a copy obtained. The licensee is in ratio today.
***See LIC809C for Continuance***
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Junell ChenTELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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 4
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: LOW, JACQUELINE
FACILITY NUMBER: 013422571
VISIT DATE: 01/28/2020
NARRATIVE
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The licensee's Pediatric CPR/First Aid certificate is not current and expired on 11/18/19. Last disaster drill log was not available at the time of inspection. Mandated Reporter training was completed on 7/11/2018 for the Licensee. Licensee has proof of immunization records as required by licensing. Safe Sleep practices were discussed, and new car seat laws were provided. Licensee was reminded that children are never to be left in a parked vehicle. A review of the Facility Personnel Report Summary indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearance or exemptions.

The following deficiencies were observed during today's inspection:
At 8:56AM, it was observed that the Licensee does not have proof of current CPR/First Aid certificate. At 9:20AM, it was observed that the Licensee does not have a current disaster drill log with one conducted at least once every 6 months. At 9:42AM, it was observed that the Licensee's assistant does not have proof of TB test completed.
See 809D for deficiencies cited today. 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. Incidental Medical Services (IMS) policy was discussed. 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 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 encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

This report shall remain on file for 3 years. A Notice of Site visit was given at time of inspection and requested Licensee to post the Notice in an unobstructed, viewable area for 30 days. Exit interview conducted with Licensee. Copy of report and appeal rights provided.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Junell ChenTELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: LOW, JACQUELINE
FACILITY NUMBER: 013422571
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/28/2020
Section Cited

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102416 Personnel Requirements: (c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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This requirement was not met as evidence by: based on observation. LPAs observed non-current CPR/First Aid certificate. This poses a potential health and safety risk to the 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.
Type B
02/04/2020
Section Cited

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102417 Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: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 be kept at the family child care home.
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This requirement was not met as evidence by: based on observation. LPAs observed missing disaster drill log. This poses a potential health and safety risk to the 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.
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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Junell ChenTELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: LOW, JACQUELINE
FACILITY NUMBER: 013422571
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/18/2020
Section Cited

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102369 Application for Initial License (9) Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.
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This requirement was not met as evidence by: based on observation. LPAs observed missing TB records in assistant Maria Cortez's files. This poses a potential health and safety risk to the 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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Junell ChenTELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4