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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376614286
Report Date: 05/10/2021
Date Signed: 05/10/2021 11:37:35 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 CAREFACILITY NUMBER:
376614286
ADMINISTRATOR:JENNIPHAR BERTHIAUMEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 847-3401
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:14CENSUS: 8DATE:
05/10/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Jenniphar BerthiaumeTIME COMPLETED:
11:45 AM
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Covid-19 State of Emergency
On May 10, 2021 at 9:50 a.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection via Zoom to follow up on a self-reported incident that occurred on 5/07/21 wherein a one year old child (child #1) collided with the licensee’s dog resulting in a small cut on the bridge of the child’s nose and a small puncture wound on his cheek. LPA met with Licensee Jenniphar Berthiaume and proceeded to tour the facility. There were 8 children present along with helpers Destiny Gutierrez and Candy Evans. There were no children present under the age of 24 months. Appropriate ratio/capacity were observed. The helpers have the required background clearances and are associated to the facility.

LPA interviewed the licensee and helper #1. On 5/07/21 at approximately 9:00 a.m. child #1 was behind the patio furniture and running towards the picnic tables. The family dog ran out of the house toward the area under the trampoline and collided with the child. The child obtained a cut on the nose and a puncture mark on his right cheek. Staff cleaned the wound and the child's parents were called. The child was taken to the the hospital where he received one stitch on his cheek. The child no longer attends the facility. At the time of the incident there were 9 children, 2 helpers and the licensee present. Helper #1 was outside in the rear yard when the incident took place with 8 children. The licensee states that she was walking between the yard and and the water dispenser located in the house at the time of the incident. The second helper was in the daycare room changing a diaper at the time of the incident. Proper ratio and supervision were in place. The licensee states that her dog, a 2.5 year old Alaskan Malamute, has had extensive obedience and off leash training.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021
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: 05/10/2021
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To prevent this type of incident from occurring again the licensee states that she will let the dog out into the yard prior to the children going into the yard so the dog will not run out excited. The licensee also states that the Humane Society will be going out to the facility today, 5/10/21, to observe the dog and to make sure he is in good health. The licensee states that the dog has had all of his required shots, is micro chipped & registered. The licensee will forward to LPA any report left by the Humane Society for review. The facility responded appropriately to the situation and reported timely. The parent of child #1 was also notified timely.

No deficiencies are cited.

An exit interview was conducted and appeal rights (LIC 9058 1/16) were discussed. A copy of this report as well as a copy of the appeal rights were emailed to the licensee at the conclusion of the inspection. The licensee will confirm receipt of this report via e-mail and the reply of confirmation will serve as the signature acknowledging these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021
LIC809 (FAS) - (06/04)
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