414004016-3-13-2020-05-CC-ACON-BMNQMK-20200313121740

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004016
Report Date: 03/13/2020
Date Signed: 03/13/2020 12:17:51 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:	MCINTYRE, VERONICA		FACILITY NUMBER:	414004016
ADMINISTRATOR:	MCINTYRE, VERONICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 290-0680
CITY:	PACIFICA	STATE: CA	ZIP CODE:	94044
CAPACITY:	14	CENSUS: 8	DATE:	03/13/2020
TYPE OF VISIT:	Annual/Random	ANNOUNCED	TIME BEGAN:	10:27 AM
MET WITH:	Veronica MCIntyre		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	On March 13, 2020 at 10:27 a.m., Licensing Program Analyst (LPA) April Cowan conducted an unannounced Annual Inspection and met with Licensee. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Present in the facility is Licensee and helper caring for 8 children (1 infants and 7 preschool age). Licensee rents home, which is a 4 bedroom, 2 bathroom house. Licensee lives in home with mother, one adult child, and one minor child. Facility was inspected and Day-care areas are: Living room, bathroom 1, and back yard. Off Limit areas are: The rest of the home. LPA observed the following: Day-care area has 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. Chimney in Living room is properly barricaded. There are no bodies of water in the home. At 10:40, LPA observed alcohol, detergents, and cleaning products accessible to day-care children. This Licensee states there are no guns or weapons of any kind in the home. Licensee’s CPR expires in 5/2020. Licensee conducted last emergency drill on 3-2-20 and is properly logged. Licensee provides daily snacks and meals. All required postings are properly posted. Licensee has required proof of immunization and Mandated Reporter Training certificate on file. >>> 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: 03/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2020

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: MCINTYRE, VERONICA	FACILITY NUMBER: 414004016
	VISIT DATE: 03/13/2020

NARRATIVE

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During inspection,
Precautions for the COVID-19 were discussed. Emergency Evacuations, Barricading off limit areas, and Home cleanings were discussed.
*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.

An exit interview was conducted and plans of Correction were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with licensee whose signature on this form confirms receipt of these documents.

> See attached page for deficiency cited today.

>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: 03/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2020

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: MCINTYRE, VERONICA	FACILITY NUMBER: 414004016
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/13/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/13/2020 Section Cited	1 2 3 4 5 6 7	102417(g)(1) Operation of a Family Child Care Home The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on LPA's observaions, licensee did not make sure that cleaning compounds and alcohol were unaccessible to children. This is a potential risk for children in care.	8 9 10 11 12 13 14
	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: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2020

LIC809 (FAS) - (06/04)

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