414001188-11-15-2019-05-CC-ACON-BHXPYD-20191115104347

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001188
Report Date: 11/15/2019
Date Signed: 11/15/2019 10:44:16 AM

COMPREHENSIVE INSPECTION

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:	BORDESSA, JODY D.		FACILITY NUMBER:	414001188
ADMINISTRATOR:	BORDESSA, JODY D.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 359-2683
CITY:	PACIFICA	STATE: CA	ZIP CODE:	94044
CAPACITY:	14	CENSUS: 12	DATE:	11/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Jody Bordessa		TIME COMPLETED:	11:00 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 November 15, 2019 at 08:25 AM (Licensing Program Analyst (LPA) April Cowan conducted an unannounced Annual Inspection and met with Licensee Jody Bordessa. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present in the facility is Licensee, husband, and helper Laura caring for 12 children (4 infants and 8 preschool age). Licensee owns home. Home is a 3 bedroom, 3 bathroom house with 2 additional rooms located on bottom floor of home. Licensee and husband live in home. Facility was inspected and Day-care areas are: 2 rooms on lower level, lower level bathroom, and back yard. Off Limits areas are: The entire upper level of home and upper level of backyard. Facility operates from 07:30 AM to 05:30 PM LPA observed the following: Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. Home has sufficient lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. Stairs in home are properly barricaded. Home has a gas fireplace that is screened. When LPA arrived, the fireplace was lit. LPA touched the fireplace screen, and held hand there for 30 seconds. LPA observed screen was warm but not hot. Licensee stated that the fireplace has been running for 3 hours that day. Backyard is properly fenced. Upper level of back yard is barricaded. Licensee has a hot tub in back yard that is properly covered and latched shut. >>> See next page

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BORDESSA, JODY D.	FACILITY NUMBER: 414001188
	VISIT DATE: 11/15/2019

NARRATIVE

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There are no poisons, detergents, or cleaning products accessible to day-care children. Licensee states there are no guns or weapons of any kind in the home. Licensee’s CPR expires in 1/10/2021. Licensee conducted last emergency drill on 09/05/19 and is properly logged. Licensee provides breakfast, lunch, and snack daily. Discipline policy is time out. Licensee states that she is aware that children should receive no more than 1 minute per age of time out discipline. All required postings are properly posted. Licensee has required proof of immunization and Mandated Reporter Training certificate on file.
During inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
*Licensee was reminded about Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or www.mandatedreporterca.com)
*Licensee was given information regarding ‘Safe Sleep’ practices.
>No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.
An exit interview was conducted. A copy of this report and appeal rights were discussed and left with licensee, Jody Bordessa, whose signature on this form confirms receipt of these documents.

>This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

LIC809 (FAS) - (06/04)

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