380505849-3-28-2022-05-CC-HLEG-CCXQEF-20220328120616

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380505849
Report Date: 03/28/2022
Date Signed: 03/28/2022 12:06:41 PM

Document Has Been Signed on 03/28/2022 12:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	HOVE, YVONNE		FACILITY NUMBER:	380505849
ADMINISTRATOR:	HOVE, YVONNE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 776-5054
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94123
CAPACITY:	12	CENSUS: 10	DATE:	03/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Yvonne Hove		TIME COMPLETED:	11:55 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	On March 28, 2022, Licensing Program Analyst (LPA), Leong, conducted an unannounced annual inspection with Yvonne Hove. LPA explained the inspection's purpose to the licensee. During today's inspection, two infants and eight pre-k children were in the care of the licensee and three staff members. The fingerprint clearance is on file for all adult residents except one for staff member who has a pending status. The daycare operates from 8:30 am -5:30 pm, Monday through Friday. The daycare areas include the Living room, Dining Area, Master bedroom, and patio. The off-limit areas include the kitchen and licensee’s bedroom that is on the back of the apartment attached by the patio. All off limit areas are properly barricaded. When a child exhibits symptom of illness, the Licensee will separate the child in the nap room while contacting the parent to arrange for the child's pick-up LPA and the Licensee conducted an inspection of the daycare areas to look for potential health and safety hazards. The daycare is outfitted with age-appropriate toys and equipment. The home is well-lit, well ventilated, and free of defects or conditions that endanger children in care. The daycare is equipped with a smoke detector, carbon monoxide detector, and a fully charged fire extinguisher. All the electrical outlets and trash cans are covered. Children have access to first aid supplies. Cleaning compounds, detergents, and other items that could endanger children are kept out of reach of children. LPA observed that the fireplace is screened and out of reach of children. Mats are available for older children to use for napping. * See Page 2 for continuation*

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

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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Document Has Been Signed on 03/28/2022 12:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HOVE, YVONNE	FACILITY NUMBER: 380505849
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. 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, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2022
	Plan of Correction
1 2 3 4	Licensee will provide a copy by due date.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(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. 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, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2022
	Plan of Correction
1 2 3 4	Licensee will provide copies by due date.

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: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HOVE, YVONNE	FACILITY NUMBER: 380505849
	VISIT DATE: 03/28/2022

NARRATIVE

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LPA saw no walkers, bouncers, or other similar items. The backyard is fenced, clean, and equipped with age-appropriate outdoor equipment. According to the Licensee, there are no firearms or weapons on the premises. LPA observed that there were no pools, spas, or other bodies of water on the property.

LPA observed that the Licensee had posted all the required forms, including the facility License, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The licensee is aware that smoking is not permitted in family childcare homes.

During the inspection, LPA went over all the children's records. Each child has an emergency information card in their file that includes their full name, phone number, and the location of a parent or other responsible adult who can be contacted in an emergency. Each child's file contained parental authorization for the Licensee or registrant to consent to emergency medical care, as well as the child's physician's name and phone number. Every six months, fire and earthquake drills are held, with the most recent drill taking place on 2/7/22.

*** See Page 3 for continuation***

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HOVE, YVONNE	FACILITY NUMBER: 380505849
	VISIT DATE: 03/28/2022

NARRATIVE

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LPA reviewed all staff records. One of the staff members maintain a current Pediatric First Aid and CPR certification, which expires on 09/2023. LPA reviewed the staff roster and one of the staff members were in pending status. LPA informed the licensee the department will notify her once the staff member name is cleared. The licensee provided a document from the department in regard to one of her other staff members receiving criminal clearance. Additionally, LPA met with the Licensee to discuss supervision and capacity expectations/requirements. Although the Licensee does not transport children, she is aware that children should never be left in vehicles unattended.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPAs discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed the Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

*** See Page 4 for continuation***

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HOVE, YVONNE	FACILITY NUMBER: 380505849
	VISIT DATE: 03/28/2022

NARRATIVE

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The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPAs reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

LPAs encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

Two deficiencies below were cited today with a plan of correction.
1. Mandated Reporter for the licensee
2. MMR and Pertussis records for all staff, including the licensee

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with Yvonne Hove

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022

LIC809 (FAS) - (06/04)

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