274405354-11-6-2019-07-CC-NROZ-BHNTAN-20191106133348

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274405354
Report Date: 11/06/2019
Date Signed: 11/06/2019 01:34:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	JACKSON, GRETCHEN		FACILITY NUMBER:	274405354
ADMINISTRATOR:	JACKSON, GRETCHEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 235-0776
CITY:	SALINAS	STATE: CA	ZIP CODE:	93907
CAPACITY:	14	CENSUS: 10	DATE:	11/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Gretchen Jackson		TIME COMPLETED:	01:45 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	Licensing Program Analyst (LPA) Nancy Rodriguez and Licensing Program Manager Tony Studebaker conducted an Annual/Random Inspection with Licensee Gretchen Jackson. Also present was helper Anna Liedke. Licensee states that a minor assistant works under adult supervision at the facility on an on call basis. The facility's hours of operation are Monday - Friday, 8:00 am - 5:00 pm. Licensee's CPR and First Aid are current and expire 9/2020. There were 10 children in care today (4 infants and 6 preschoolers.) LPA reviewed 6 children's files. Each file contained required Immunization Record and Notification of Parent's Rights. Three staff files were reviewed. Each file contained record of required immunization. LPA toured the indoor and outdoor areas of the home during today's visit. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's visit. Last fire drill was conducted on 09/10/19. There is a working smoke alarm and carbon monoxide detector on the premises. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the children in care. The home is clean, orderly, and safe for the day care children. LPA did not observe a wall heater in the home (central heat). Off limit areas in the home are as follows: entire second floor, and the garage. LPA observed securely gated staircase and a barricaded fireplace. In the back yard there is an enclosed deck area for children's play and an unfenced play area with a climbing structure. LPA reminded Licensee that the children must be supervised at all times whenever they are outside in the back yard/ play area. There is an outside cat and a dog in a kennel in the garage with current vaccinations. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, poisons, medications, and other similar items are out of reach and inaccessible to children. Licensee states that she does not administer any medications at this time.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Nancy Rodriguez	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: JACKSON, GRETCHEN	FACILITY NUMBER: 274405354
	VISIT DATE: 11/06/2019

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
26
27
28
29
30
31
32

LPA also went over safe sleep for infants. www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

Licensee was provided The Effects of Lead Exposure pamphlet for review and was informed that she must provide a copy to each family.

A review of staff records on 11/6/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. A $500 immediate civil penalty. An ongoing $100 per day per violation continues until the violation(s) is corrected.

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

Department website: www.ccld.ca.gov reviewed with Licensee. Provider has subscribed to receive Provider Information Notices.

No deficiencies were cited, exit interview conducted, and a copy of this report was provided to the Licensee.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Nancy Rodriguez	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2