414004462-5-14-2019-05-CC-LGOZ-BC6U32-20190514151248

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004462
Report Date: 05/14/2019
Date Signed: 05/14/2019 03:13:03 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:	PORTILLO, JESSICA J.		FACILITY NUMBER:	414004462
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 7	DATE:	05/14/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Jessica Portillo		TIME COMPLETED:	03:30 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), Luis J. Gomez, met with Licensee, Jessica Portillo. Purpose of the inspection was explained and was for an Annual/Random inspection. Present in the facility is Licensee caring for 7 children (1 infant, 6 PreK). LPA observed licensee is over her capacity limits of the License. Licensee rents home, which is a 3 -bedroom, 1 bathroom, 2- level house. Hours of Operation are: Mon- Fri 8:30-5:30pm Daycare areas are: Playroom Area #1, Playroom Area #2, Dining Area, Backyard, Bathroom #1, Bedroom #1 and Bedroom #2 Off Limit areas are: Kitchen and Bedroom #3. All off limit areas are properly barricaded with child safe fencing. LPA observed the following: Daycare area is clean, orderly, and equipped with age appropriate toys and equipment for the children. Home has ample lighting throughout the home. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. Chimney is properly barricaded and inaccessible to children in care. LPA observed a pet dog in the home. Licensee stated all vaccinations are current. There are no bodies of water in the Home. There are no poisons, detergents, cleaning products, or sharp objects accessible to daycare children. Licensee states there are no guns or weapons in the home. Licensee’s CPR certifications expire: 9/2019. Licensee states she will be attending a renewal CPR class before it expires. Licensee conducted last emergency drill on 3/1/2019. All required postings are properly posted next to the front door. Licensee stated she provides daily snacks and meals for Prek children in care. Licensee stated parents bring meals for infant child in care. LPA reviewed Personnel files during today’s inspection. Licensee and helper have required proof of immunization and Mandated Reporter Training certificate on file. LPA reviewed Children’s files and roster during todays inspection. LPA observed files and roster are complete and up to date. See Page 2. . .

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019

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: PORTILLO, JESSICA J.	FACILITY NUMBER: 414004462
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/14/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/21/2019 Section Cited CCR 102416.5(a)	1 2 3 4 5 6 7	102416.5(a) Staffing Ratio and Capacity. The capacity as specified on the license shall be the maximum number of children for whom care can be provided.	1 2 3 4 5 6 7	Licensee will reduce her capacity to meet the license requirements for a small capacity licensee. Infant Prek School Age 4 0 0 3 3 0 2 4 1 1 5 2 0 6 2
	8 9 10 11 12 13 14	This requirement was not met as evidenced by LPA observed licensee is over her capacity limits of the License. This is an immediate health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		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) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019

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: PORTILLO, JESSICA J.	FACILITY NUMBER: 414004462
	VISIT DATE: 05/14/2019

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

Page 2. . .
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.

>See attached deficiencies page for deficiencies issued today under Title 22 Division 12 of the Ca. Code of Regulations.

>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: Alma Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3