214200105-3-16-2022-05-CC-KMEO-CCKPAY-20220316110930

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214200105
Report Date: 03/16/2022
Date Signed: 03/16/2022 11:10:06 AM

Document Has Been Signed on 03/16/2022 11:10 AM - 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	JAEGER, HEIDI & WALLY		FACILITY NUMBER:	214200105
ADMINISTRATOR:	JAEGER, HEIDI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 453-9976
CITY:	SAN ANSELMO	STATE: CA	ZIP CODE:	94960
CAPACITY:	14	CENSUS: 6	DATE:	03/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Licensee, Heidi Jaeger		TIME COMPLETED:	11:15 AM

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 March 16th, 2022 at 9:40am, Licensing Program Analyst (LPA) Kassandra Medrano conducted an annual required inspection which included a toured the home and yard, and a review of the required day-care forms with the licensee today. At 9:47am LPA observed, Present in the home is Licensee, 4 infants and 2 toddlers. Ratio requirements are not in compliance. Capacity and ratio requirements of children was observed in compliance today. This type of home is a two story, single family home. Off limit rooms were identified as entire second floor. A review of records indicates that all adults working or living in the home who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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. Licensee owns home.The day-care operates 6:30am-5:30pm, Monday through Friday. Licensee has day-care insurance through Allstate. LPA observed the following: Stairs in the home are properly barricaded at top/bottom if caring for children under five years old. Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. No baby walkers, bouncers, exercausers, etc. allowed to be used during day-care hours. Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. There is a pool in the backyard, and properly barricaded. There is a fireplace in the day-care area. There are no detergents, or cleaning products accessible to day-care children. Poisons are locked. Licensee states there are no guns or weapons of any kind in the home. The yard is fenced. Licensee’s CPR and First Aid expires 11/2023. Emergency drills are conducted at least once every six months and properly logged. Licensee provides daily snacks and meals. Isolation of sick children reviewed/discussed

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JAEGER, HEIDI & WALLY	FACILITY NUMBER: 214200105
	VISIT DATE: 03/16/2022

NARRATIVE

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Children’s roster was reviewed and is complete and up-to-date. Children files were reviewed and are complete. Supervision and transportation of children was discussed. Capacity options were reviewed. Licensee understands that care cannot be provided for more than the capacity as stated on the license. Requirements for reporting suspected child abuse was discussed, as well as reporting requirements for unusual incidences. All required postings are properly posted (License/Parent’s Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist) Licensee has updated immunization's and Mandated Reporter Training on file. Licensee was reminded that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. Licensee was informed about the Provider Information Notices (PINs) on CCLD website. Licensee was reminded about Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or www.mandatedreporterca.com). 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. No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations.This report and appeal rights were discussed with Licensee. This report must be available in the facility for public review. Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Heidi. To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

This Type A citation page shall be posted for 30 days along with the Notice of Site Visit. This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB 633 requirements.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/16/2022 11:10 AM - 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JAEGER, HEIDI & WALLY	FACILITY NUMBER: 214200105
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(b)(2)

Staffing Ratio and Capacity

(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (2) Six children, no more than three of whom may be infants; or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in which licensee was alone with 4 infants and 2 toddlers which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/17/2022
	Plan of Correction
1 2 3 4	Licensee called parent for immediate pick up, Licensee to unenroll a child to meet capacity requirements.

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: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

LIC809 (FAS) - (06/04)

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