376614286-8-15-2019-51-CC-JARL-BF3MAC-20190815092607

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376614286
Report Date: 08/15/2019
Date Signed: 08/15/2019 09:26:13 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	BERTHIAUME, JENNIPHAR FAMILY CHILD CARE		FACILITY NUMBER:	376614286
ADMINISTRATOR:	BERTHIAUME, JENNIPHAR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 847-3401
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92120
CAPACITY:	14	CENSUS: 7	DATE:	08/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	07:45 AM
MET WITH:	Jenniphar Berthiuame		TIME COMPLETED:	09:22 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	Licensing Program Analyst (LPA) Jo Ann Legaspi conducted an unannounced inspection with the Licensee. The home was toured and inspected to ensure a safe environment for the care and supervision of children. The daycare has three (3) bedrooms, two (2) bathrooms, children’s room (converted garage), open kitchen/dining/living room area. The daycare is a single-family unit with one (1) floor. Present in the home was the Licensee, one (1) helper, one (1) volunteer and seven (7) daycare children. The fire extinguisher, carbon monoxide, and smoke detectors satisfy requirements and are operational. The last safety drill was on 05/15/2019. Hazardous items were secured inaccessible to children. The hot tub is in the fenced backyard. The hot tub was properly secured with a locked cover which supported LPA’s weight. The daycare uses a kiddie pool which meaures 122 inches x 74 inches x 51 inches. The kiddie pool was devoid of water; it is only used when children play outside in water and emptied immediately after use. There are no weapons in the home, per the Licensee. A review of staff records indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. First Aide and CPR certifications expire in December 2019. Reviewed children records were observed to be complete. Licensee has provided adequate space for the children to eat, sleep and play within the home. The daycare room, bathroom, backyard, covered backard porch are used for child care. The Licensee has sufficient toys and available equipment. All equipment that is used should be used only as intended by the manufacturer. The home has a fenced backyard available for outdoor activities. The Licensee acknowledged continuous visual supervision will be used whenever children are engaged in outdoor activities. LPA provided and reviewed with Licensee the YMCA’s Behavioral Support Program. LPA provided and reviewed with Licensee Provider Information Notice (PIN) 19-06-CCP, which states the US Consumer Product Safety Commission has issued a safety recall of specific sleepers due to several infant deaths. LPA provided Licensee with PIN 19-02-CCP regarding Safe Sleep Awareness, additional written information and information

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: BERTHIAUME, JENNIPHAR FAMILY CHILD CARE	FACILITY NUMBER: 376614286
	VISIT DATE: 08/15/2019

NARRATIVE

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resources about safe sleep techniques. LPA and Licensee discussed those methods of protected slumber. LPA provided and discussed with Licensee PIN 19-08-CCP, which describes new immunization requirements issued by the Department of Public Health. Licensee was also provided with written information regarding lead exposure as described in Assembly Bill 2370. LPA further provided and discussed with Licensee PIN 19-07-CCP, which provided information regarding radon toxicity and free testing. Also provided to the Licensee was the “Heart and Nutrition” newsletter. Licensee and LPA reviewed these issues. LPA and Licensee discussed California Megan's Law. LPA provided the website: www.meganslaw.ca.gov. The Licensee was advised of their responsibility to be current on all regulatory changes by viewing the Community Care Licensing webpage at www.ccld.ca.gov. LPA advised the Licensee of the Child Care Advocate Program.

The provider was reminded of the following: report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances to avoid civil penalties associated with this requirement; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care.

The 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 Community Care Licensing. 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.

LPA provided the Licensee with the Notice of Site Visit – LIC 9213, which is to be posted for thirty (30) days.

Based on today's visit, no deficiencies were observed. An exit interview was conducted with the Licensee, who was provided a copy of their Licensee Rights (LIC 9058 1/16). Their signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

LIC809 (FAS) - (06/04)

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