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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310287
Report Date: 05/30/2019
Date Signed: 05/30/2019 03:40:25 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:JEANBLANC, JESSICAFACILITY NUMBER:
304310287
ADMINISTRATOR:JEANBLANC, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 674-0158
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:14CENSUS: 12DATE:
05/30/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Jessica JeanblancTIME COMPLETED:
03:45 PM
NARRATIVE
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An inspection was conducted at the facility by Licensing Program Analyst (LPA) Stacy Torrence. LPA met with Jessica Jeanblanc, who guided analyst on a tour of the facility inside and outside. Also present was Licensee's assistant Erika Del Real. There were 12 children present. Licensee has 18 children enrolled. Licensee has a current children’s roster available. Licensee states that three adults and two children live in the home. Operation hours are 7:00 am to 5:30 pm, M-F. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

This is one-story home which consists of four bedrooms, two bathrooms, living room, dining room, kitchen, office, attached garage, front yard (not fenced) and back yard (fenced). Off-limit areas are 4 bedrooms, one bathroom, and attached garage. Areas that children and parents have access to are: one bathroom, add-on room (daycare), kitchen, dining room, front yard, and back yard (fenced). The licensee and assistants pediatric CPR/First Aid certification is not current. Items which could pose a danger to children were not accessible to children. Poisonous items were not observed during today's inspection. The smoke detector and carbon monoxide were tested and are operable. Appropriate fire extinguisher is in the house and fully charged. Emergency Disaster drill log within the past six months was available. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit. Children's records: parents' rights and California School Immunization Record were reviewed.

Incidental Medical Services-IMS was discussed. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. 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
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: JEANBLANC, JESSICA
FACILITY NUMBER: 304310287
VISIT DATE: 05/30/2019
NARRATIVE
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Licensee has proof of immunization against pertussis, measles and flu. Licensee’s three assistant does not have proof of immunization against pertussis, measles, and flu. Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. Licensee and assistants do not have proof of completion of the required Mandated Reporter Training. LPA advised Licensee and assistants to complete training and submit proof of completion certificate to the department. Website provided: http://mandatedreporterca.com/.

During this inspection, there were deficiencies cited per CA Code of Regulations Title 22-see 809-D page.

Exit interview was conducted. Report reviewed and discussed with the licensee. Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report. http://www.ccld.ca.gov/http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htmhttp://cchp.ucsf.edu/content/disaster-preparedness. Licensee was informed how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.


SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: JEANBLANC, JESSICA
FACILITY NUMBER: 304310287
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/30/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2019
Section Cited
CCR
10236.8(d)
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10236.8(d)As a condition of licensure, the licensee shall comply with the requirements for training in preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, as specified in Health and Safety Code Section 1596.866. This requirement is not met as evidence by record review of Licensee,
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Per Licensee, she will submit proof to LPA by POC due date of 06/27/19 via email.
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and 2 staff have does not have current Pediatric First Aid/CPR. This poses a potential risk to the safety of children in care.
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Type B
06/27/2019
Section Cited
HSC
1597.622(a)(1)
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1597.622(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Per Licensee, she will submit proof to LPA by POC due date of 06/27/19 via mail.
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The requirement is not met as evidence by record reivew of staff 1 and staff 2, missing proof of immunization against Pertussis, Measles, and Flu vaccine. This poses a potential risk to the health of children in care.
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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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3