376628981-2-2-2022-20-CC-LGAO-CBA2VG-20220202164355

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376628981
Report Date: 02/02/2022
Date Signed: 02/02/2022 04:44:48 PM

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:	PIERRE, MARIE FAMILY CHILD CARE		FACILITY NUMBER:	376628981
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	02/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Marie Pierre		TIME COMPLETED:	04:45 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	On February 2, 2022, at 10:00 AM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with the licensee, Marie Pierre. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Seven (7) children and the licensee and her helper roommate, Kerline Jean-Phillipe, were present in the facility during this inspection. Two of the children in care are Ms. Jean-Phillipe's own two children .This facility is a one floor, four bedroom, two bathroom home. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: the living room, the last bedroom and the day care bathroom. Off limits areas are the remaining three home bedrooms and the kitchen. The bedrooms are made inaccessible through use of locking door handles. The kitchen is made inaccessible with a child safety gate that is installed in the entrance way between the kitchen and the living room. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. The home has a fenced backyard available for outdoor activities. No bodies of water observed on the premises during the inspection. Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee’s First Aid and CPR certifications expire in August of 2022. Licensee has required immunizations. Licensee completed Mandated Reporter Training on 07/23/20 Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 01/15/22. There is one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards are free from all loose articles and objects. The provider states she does physically check on sleeping infants every 15 minutes but currently doesn't keep a Safe Sleep Log An Individual Infant Sleeping Plan [LIC 9227 (3/20)] has not been maintained for each infant up to 12 months of age. The provider states she does place infants up to 12 months of age on their backs for sleeping.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

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 10

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: PIERRE, MARIE FAMILY CHILD CARE	FACILITY NUMBER: 376628981
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(a)

Infant Safe Sleep

(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above as during inspection analyst found that licensee only had two cribs available for the three infants in care which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/02/2022
	Plan of Correction
1 2 3 4	Licensee corrected deficiency during visit as she had a playpen that had equipment stored in it in the napping room cleared out and is now available for use.

Type B

Section Cited

CCR

102425(j)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as she did not keep a sleep log for the infants in care which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/14/2022
	Plan of Correction
1 2 3 4	Licensee states she was unaware of new sleep regulations. Licesnsee was provided with a copy of the Infant Safe Sleep regulations and a copy of a sample safe sleep log and states she will document the safe sleep requirements including any labored breathing, signs of distress etc for the infants in care beginning immediately. She will then send analyst a copy of completed logs for the sample period of 02/03/22 to 02/13/22 by 02/14/22.

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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

Page: 2 of 10

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: PIERRE, MARIE FAMILY CHILD CARE	FACILITY NUMBER: 376628981
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(C)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: Infants up to 12 month of age who are sleeping in a position other than on their back. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as she did not keep a safe sleep log for infant #1 who is under 12 months of age to check if she was sleeping in a position other than her back which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2022
	Plan of Correction
1 2 3 4	Licensee was provided with a copy of the Infant Safe Sleep regulations and a copy of a sample safe sleep log and understands she is required to indicate whenever a child under 12 months of age is found to be sleeping on any position other than on their back. Licensee states she will read through the regulations and send analyst a statement indicating same by 02/09/22 as well as continue the practice from this point on.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above as it was found that her assistant, Kerline Jean-Phillippe, did not have record of required immiunizations on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/02/2022
	Plan of Correction
1 2 3 4	Licensee states that Ms. Jean-Phillipe does have her required immunizations but that they currently do not have copies at the faciltiy. Licensee states she will obtain copies and send them to analyst by 03/02/22 to complete the correction.

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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

Page: 3 of 10

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: PIERRE, MARIE FAMILY CHILD CARE	FACILITY NUMBER: 376628981
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.1(a)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above as analyst found licensee had no records for assistant Kerline Jean-Phillipe including shot records, TB test results, etc. which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/02/2022
	Plan of Correction
1 2 3 4	Analyst will provide licensee with required items needed for assistant's file. Licensee states she will gather and have helper complete required documenation to keep in own personnel file and send analyst a copy of documents by 03/02/22 to complete the correction.

Type B

Section Cited

CCR

102418(g)(1)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review the licensee did not comply with the section cited above as when analsyt went through facility files he found that children's shot records were not transfered to required PMS 286 cards which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/16/2022
	Plan of Correction
1 2 3 4	Analyst provided licensee with blue immunization cards and licensee stated that she will complete the transfer and send analyst copies of the cards by 02/16/22 to complete the correction.

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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

Page: 4 of 10

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: PIERRE, MARIE FAMILY CHILD CARE	FACILITY NUMBER: 376628981
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as analyst found that there was no Individual Infant Sleeping Plan on file for child #1 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2022
	Plan of Correction
1 2 3 4	Analyst provided licensee with a copy of the LIC 9227 to give to the parent of any infant enrolled in the day care up to 12 months of age. Licensee was given a copy of the Infant Safe Sleep regulations to review and states will send analyst a statement by 02/09/22 indicating that she has completed the review and understands the requirement.

Type B

Section Cited

CCR

102425(d)

Infant Safe Sleep

The provider shall place infants up to 12 months of age on their backs for sleeping. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above when analyst found infant #1 who is less than 12 months old put to sleep on her stomach which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2022
	Plan of Correction
1 2 3 4	Analyst provided licensee with a copy of the infant safe sleep regulations and licensee now understands that infants less than 12 months old must always be placed on their backs for sleep unless they have a medical exemption. Licensee states she will read through the regulations and send analyst a statement indicating same by 02/09/22 as well as continue the practice from this point on.

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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

Page: 5 of 10

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: PIERRE, MARIE FAMILY CHILD CARE	FACILITY NUMBER: 376628981
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Infant Safe Sleep


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Type B

Section Cited

CCR

102416.5(b)(2)

Staffing Ratio and Capacity

(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (2) Six children, no more than three of whom may be infants; or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in as she had 7 children in the home, four of whom were infants, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/04/2022
	Plan of Correction
1 2 3 4	Licensee had seven children in her faciity today including two who belonged to her roommate helper and four of whom were infants. Licensee stated that child #1 only typically only attends on Saturdays but just dropped by today due to an emergency. Analyst met with parents during pick up who confirmed Ms. Pierre's account. Parents will send analyst a statement confirming child is only there for Saturday care when no other children are present.

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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

Page: 6 of 10

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: PIERRE, MARIE FAMILY CHILD CARE	FACILITY NUMBER: 376628981
	VISIT DATE: 02/02/2022

NARRATIVE

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LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements 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.

Nine type B violations California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

Page: 10 of 10