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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393610611
Report Date: 09/27/2019
Date Signed: 09/27/2019 01:02:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:THOMAS, JACQUELINE & TERRYFACILITY NUMBER:
393610611
ADMINISTRATOR:THOMAS, JACQUELINE & TERRYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 835-7801
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY:14CENSUS: 12DATE:
09/27/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Jacqueline ThomasTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alecia Sifuentes met with licensee, Jacqueline Thomas for the purpose of an unannounced annual random inspection. Also present was Licenses spouse, Terry Thomas. Licensee stated there are no new residents in the home since the initial license. All individuals subject to a criminal background review have obtained a criminal record clearance. A health and safety inspection was conducted in all areas of the home accessible to children in care. Off-limits areas include upstairs, laundry room, and garage. Licensee acknowledged that children may never enter these off-limits areas.

LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. There are no bodies of water on the premises. Toxic and hazardous items are inaccessible to children. The fireplace in the home is appropriately barricaded to prevent access by children and outdoor play space is fenced. Toys are age appropriate.

Four children’s files were reviewed. LPA observed immunization records, emergency information, and signed Family Child Care Home Notification of Parents' Rights in children's files. A current roster is being maintained and fire and disaster drills were conducted at least once every six months and documented. The licensee’s immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. AB 1207 Mandated Reporter Training was verified and expires on 4/3/2020. LPA discussed recent changes in licensing requirements, including the posting of licensing inspection notices and reports and Parent Notification Requirements. LPA discussed overdue fees with licensee.

LPA discussed recent changes in licensing requirements, including SB 277 (no longer accepting religious beliefs for immunizations) and SB 792 pertaining to immunization requirements for children and staff. Licensee provided proof of staff immunization's.

Report continues on 809-C.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: THOMAS, JACQUELINE & TERRY
FACILITY NUMBER: 393610611
VISIT DATE: 09/27/2019
NARRATIVE
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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 new Mandated Reporter Training with licensee. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. In addition, existing licensees must meet requirements by March 30, 2018. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English.

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 provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates. LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures.

This facility evaluation report was reviewed and discussed with the licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.



In the areas that were evaluated, deficiency was observed at the time of the visit and cited on LIC 809D. An exist interview was conducted and report was reviewed with licensee who stated she understands todays inspection. Notice of Site Visit posted and licensee understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
LIC809 (FAS) - (06/04)
Page: 2 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: THOMAS, JACQUELINE & TERRY
FACILITY NUMBER: 393610611
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2019
Section Cited

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Licensees of family day care homes shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric CPR issued by the American Red Cross, the American Heart Association, or by a training program that has been approved by the Emergency
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Medical Services Authority pursuant to this section and Section 1797.191 shall be onsite at all times when children are present at the facility, and shall be present with the children when children are offsite.
LPA observed Licensee's CPR & First Aid expired on 7/13/2018.
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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: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2019
LIC809 (FAS) - (06/04)
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