414002538-9-20-2019-05-CC-ACON-BG7QLZ-20190920121647

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002538
Report Date: 09/20/2019
Date Signed: 09/20/2019 12:17:04 PM

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:	KERSEG, SARAH E.		FACILITY NUMBER:	414002538
ADMINISTRATOR:	KERSEG, SARAH E.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 341-9716
CITY:	FOSTER CITY	STATE: CA	ZIP CODE:	94404
CAPACITY:	14	CENSUS: 12	DATE:	09/20/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Amelia Garcia		TIME COMPLETED:	12:35 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	Licensing Program Analyst (LPA) April Cowan conducted an annual random inspection which included an inspection of the home and yard, and a review of the required day-care forms with the licensee today. Present in the home is Licensee’s helper and Theresa Garcia (additional helper). Licensee is on vacation this week. LPA spoke with licensee on the telephone and is aware that LPA is conducting inspection with helper Amelia. Capacity and ratio requirements of children was observed in compliance today. This type of home is a single family, two story home. Day-care area is lower level classroom and bedroom located at end of the home. Off limit rooms were identified as the entire upper level of home. Adults living in the home are Licensee, licensee’s husband, and two children. A review of records indicates that all adults working or living in the home who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee owns home. The daycare operates Monday – Friday 8:30am – 3:30 pm. Stairs and off-limit areas are baracaded. -Daycare area is clean, orderly, and equipped with age appropriate toys and equipment for the children. No baby walkers, bouncers, exercausers, etc. allowed to be used during day-care hours. -Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. -There is a swimming pool on the property and is barricaded with a combination locked gate. There is not a fireplace in the daycare area. There are no detergents, or cleaning products accessible to daycare children. Poisons are locked. Spoke with licensee on phone. Licensee states there are no guns or weapons of any kind in the home. -The yard is fenced. -There is 1 pet fish in the home. Licensee’s CPR and First Aid expires 01/29/2020. Emergency drills are conducted twice monthly and are properly logged. Licensee provides provides daily snacks for children and parents send lunch for their children. On Fridays, parents send sharable snacks for all children. Discipline used is mainly redirection and talking to children. Isolation of sick children reviewed/discussed. Children’s roster was reviewed and is complete and up-to-date. Children and staff files were reviewed today. Supervision and transportation of children was discussed. LPA stated that care cannot be provided for more than the capacity as stated on the license.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

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: KERSEG, SARAH E.	FACILITY NUMBER: 414002538
	VISIT DATE: 09/20/2019

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
26
27
28
29
30
31
32

Reporting suspected child abuse was discussed, as well as reporting requirements for unusual incidences. All required postings are properly posted (License/Parent’s Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist). Licensee has updated immunizations on file. 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 stated 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.

Provider Information Notices (PINs) on CCLD website were discussed

Mandated Reporter Training was discussed. Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com)

> See attached page for deficiency cited today.

This report and appeal rights were discussed with Licensee. This report must be available in the facility for public review. Notice of Site Visit was posted. Notice to remain posted for 30 days.

If necessary:
This Type A citation page shall be posted for 30 days along with the Notice of Site Visit. This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB 633 requirements.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

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

FACILITY NAME: KERSEG, SARAH E.	FACILITY NUMBER: 414002538
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/20/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/27/2019 Section Cited	1 2 3 4 5 6 7	102370(d)(1) Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption required by the Department. This requirement is not met as evidence of record review conducted. During today's inspection, helper Teresa Garcia's name did not appear on the Fingerprint Clearance list. Also, there is no paperwork in licensee's files showing a clearance was requested. This poses an immediate risk to the health and safety, or personal rights of children in care.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3