376615178-9-17-2019-20-CC-RGOU-BG4N6Z-20190917101157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376615178
Report Date: 09/17/2019
Date Signed: 09/17/2019 10:12:06 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:	MILLER, JACQUELYNN FAMILY CHILD CARE		FACILITY NUMBER:	376615178
ADMINISTRATOR:	JACQUELYNN MILLER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 501-1290
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92114
CAPACITY:	14	CENSUS: 12	DATE:	09/17/2019
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Jacquelynn Miller		TIME COMPLETED:	10:20 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) Rajani Goudreau conducted an unannounced 3 year required inspection. Upon arrival, LPA met with Jacquelynn Miller, licensee. Also, present in the home licensee’s assistant. There were 12 children in care during facility inspection. Facility is within ratio and capacity limitations.Operation hours are Monday through Friday from 7:00am to 5:30pm. LPA conducted a tour of the home/outdoor play area to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3. Licensee has provided adequate space for the children to eat, sleep and play within the home. The home is kept is kept clean and orderly, with heating and ventilation for safety and comfort. Areas used for child care include: living room, family room, kitchen, bedroom #1, bathroom #2, front and back yard. Off limits areas of the home include: garage, bathroom #2 and second story of home. Off limit areas of the home are made securely inaccessible. All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children and poisons are to be locked away. The fire extinguisher, smoke and carbon monoxide detector meet requirements and are operational. Children’s toys and play equipment are safe and age appropriate. Stairs are securely barricaded. Primary telephone is a cell which is operational. There are no firearms or other weapons in the home, per licensee. Licensee has all appropriate forms posted. Screened gas fire place located in family room is not in use. In addition, gas fire place is turned off with a key lock, per licensee and LPA observation. LPA did not observe any bodies of water during facility inspection. Outdoor play area is fenced and free of hazardous items, per LPA observation. LPA advised licensee to provide direct supervision when children are playing outside. Children’s records and roster reviewed and complete. Pediatric CPR and First-Aid certificate are valid through 05/2021. There are no new adults living or working in the home. All adult residents and assistants have criminal record clearance/exemptions and child abuse index clearances. Last fire/earthquake drill was conducted on 09/12/19. See LIC809-C continuation page...

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

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: MILLER, JACQUELYNN FAMILY CHILD CARE	FACILITY NUMBER: 376615178
	VISIT DATE: 09/17/2019

NARRATIVE

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During file review, licensee and assistant did not have the required immunization's (pertussis, measles, influenza) on file for review. Licensee indicated she and assistant have had the required immunization's. However, verification is not file. LPA informed licensee of the required immunization requirement. In addition, Licensee and assistant did not have the AB1207 Mandated Reporter Training certificate on file, per file review. Licensee indicated she was unaware of the required training. LPA discussed with licensee the requirement of the Mandated Reporter training. Licensee indicated she and all staff will complete the required training. Licensee acknowledges understanding of the provider/employee immunization and Mandated Reporter training requirements.

LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. To access Child Care Licensing Regulations and Forms visit the following website: http://ccld.ca.gov. LPA discussed and provided licensee with the following: Child Care Advocates - (916) 654-1541 and email address childcareadvocatesprogram@dss.ca.gov. In addition, for common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248.

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

LPA discussed the following with Licensee: reporting suspected child abuse & neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in home have criminal background clearances to avoid civil penalties, emergency drills conducted every 6 months, heat-related illness, child passenger law, unusual incidents and time frames, information on SIDS, shaken baby syndrome, lead poisoning effects brochure. LPA informed licensee corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during day care operation.

No deficiencies issued during today’s inspection. Two technical violation advisory notes issued for provider/employee immunization's and mandated reporter training certificate not on file. An exit interview was conducted with licensee. A copy of this report was left at the facility. Analyst printed a copy of the Notice of Site Visit today. Licensee shall post the notice of site visit for 30 days from today’s visit. LPA observed licensee post notice of site visit.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

LIC809 (FAS) - (06/04)

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