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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004124
Report Date: 10/22/2019
Date Signed: 10/22/2019 04:22:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ARMENTA, JESSICA E.FACILITY NUMBER:
384004124
ADMINISTRATOR:ARMENTA, JESSICA E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 347-7271
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 11DATE:
10/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Jessica E. ArmentaTIME COMPLETED:
04:45 PM
NARRATIVE
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2, Licensing Program Analyst conducted an annual random inspection today. The purpose of the inspection was explained. There are 11 children (4 infants), licensee, Jessica, and two helpers present today. LPA reviewed the personnel summary report with Jessica, she said it's correct. Both helpers do not have fingerprint clearance on file. Jessica said she made an appointment for both staffs to get a fingerprint on Thursday and Friday. Both staff members can not come back to the facility until the fingerprint is cleared. Jessica said she will pull one of the staff members from her mom's facility to work for her in the meantime. Daycare areas: living room, dining room, bedroom #1 (front), hallway bathroom, and backyard. The remaining areas are off-limit. Current residents are licensee, Jessica, her husband, her grandmother, and their 2 sons ( 3 years old, 8 months old). LPA observed an infant bouncer in bedroom #1, licensee said she doesn't use it for the daycare children. The infant bouncer is for her son only. The licensee has current CPR & 1st until 3/2021. LPA discussed the Mandated Reporter Training, AB1207 that was effective on 1/1/2018. All staff must take the training and keep the certificate on file. The training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. https://www.mandatedreporterca.com/. Both staff members need to take AB1207.
Staff members need to have required immunization on file.

Follow up inspection will be conducted.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019
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 3
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: ARMENTA, JESSICA E.
FACILITY NUMBER: 384004124
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2019
Section Cited

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102370 (d)(1):Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department.

Both helpers do not have fingerprint clearance. Licensee said she scheduled them on Thursday, Friday.
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This requirement is not met as evidenced by records review. Civil penalty of $200 was issued today.

This poses an immediate safety risk to children in care.
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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: ARMENTA, JESSICA E.
FACILITY NUMBER: 384004124
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/05/2019
Section Cited

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H&S 1596.7995(a)(1): Staff Immunization:
Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center 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.
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Staff members do not have proof of staff immunization's (measles), TDAP, TB, Flu for review during inspection.

This poses a potential health risk to children in care.
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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3