013422571-3-24-2022-52-CC-JSAI-CCTTZZ-20220324151109

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422571
Report Date: 03/24/2022
Date Signed: 03/24/2022 03:11:22 PM

Document Has Been Signed on 03/24/2022 03:11 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	LOW, JACQUELINE		FACILITY NUMBER:	013422571
ADMINISTRATOR:	LOW, JACQULINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 875-5649
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94578
CAPACITY:	14	CENSUS: 10	DATE:	03/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Licensee, Jacqueline Low		TIME COMPLETED:	03:25 PM

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Licensing Program Analyst (LPA), Jyoti Saini met with Licensee, Jacqueline Low for an annual Random inspection. Purpose of the inspection was explained. Present during this inspection was Licensee and helper supervising 6 infants, and 4 preschoolers. Licensee lives in the house with her husband and two minors. The home is single story consisting of the living/dining room area, kitchen, family room, four bedrooms, and four bathrooms, garage, and backyard.

ON LIMITS: The living room, dining room, converted garage/play area, one bathroom, and portion of the backyard.

OFF LIMITS: The kitchen, family room, four bedrooms, and two bathrooms.

The off-limits areas for children are made inaccessible by child safety gate. Chemical, detergents, cleaning compounds, medications, and other items of this nature are made inaccessible to children. First aid supplies are available for children. Home has a fully charged fire extinguisher, and functioning smoke and carbon monoxide detectors. Provider states there are no guns or weapons in the home. LPA did not observe any body of water in the day care area. The home is clean and orderly with sufficient lighting and ventilation. There is a pet dog in the home. Last fire drill was conducted on 01/12/2022 and properly logged. Provider's and helper's CPR expires in 03/2024. Home has age appropriate toys and equipment available for the children in care. All the Postings are posted in the main playroom of the Daycare area. Provider is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. A copy of the children’s roster was available for review and copy was obtained.

During Inspection, Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

see next page.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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: LOW, JACQUELINE	FACILITY NUMBER: 013422571
	VISIT DATE: 03/24/2022

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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-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Type A deficiency is cited today( Please see attached LIC809-D)

LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAYS VISIT WITH THE NOTICE AND LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR AB 633 FACT SHEET AND A COPY OF ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT.

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

Exit interview conducted and report was reviewed with the licensee, Jacqueline Low

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/24/2022 03:11 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
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: 03/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(d)

Staffing Ratio and Capacity

(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations interviews,record review, the licensee did not comply with the section cited above. LPA observed that the facility has six infants and 4 preschoolers present in the home simultaneously, placing the facility out of ratio. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/25/2022
	Plan of Correction
1 2 3 4	Licensee shall submit a plan of correction to demonstrate how she is going to maintain the day care within ratio and capacity by 03/25/2022. LPA discussed ratio requirements for a large Family Child Care Home with Licensee.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC809 (FAS) - (06/04)

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