414004462-4-27-2022-05-CC-BVAN-CDVRTB-20220427131805

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004462
Report Date: 04/27/2022
Date Signed: 04/27/2022 01:19:23 PM

Document Has Been Signed on 04/27/2022 01:19 PM - It Cannot Be Edited

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:	PORTILLO, JESSICA J.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 766-6443
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY:	14	CENSUS: 11	DATE:	04/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Alison Meier and Silvia ReinaGutierrez		TIME COMPLETED:	01:30 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	On April 27, 2022, Licensing Program Analyst (LPA), Van, conducted an unannounced required annual inspection and met with helpers Alison Meier and Silvia ReinaGutierrez. Per Ms. Meier, the Licensee was out of town. The purpose of the inspection was explained and granted entry to the home by the helper. Present today are eleven children (6 infants and 5 preschoolers). The facility did not comply with the license capacity and limitations today. Licensee rents home, a 3 -bedroom, one bathroom, 2- level house. Daycare areas are Playroom #1, Playroom #2, Dining Area, Bedroom #1, Bedroom #2, backyard, and Bathroom #1. Off Limit Areas are Kitchen and Bedroom #3. All off-limit areas are properly barricaded with a baby gate or fencing. Days and operation hours are 8:30 am – 5:30 pm, Monday – Friday. LPA toured and inspected inside and outdoor play areas for health and safety hazards during the inspection. The daycare area is clean, orderly, and equipped with safe, age-appropriate toys, books, and play equipment. The home has adequate heating, lighting, and ventilation and is free from defects or conditions that endanger children in care. The home is equipped with a fully charged fire extinguisher, smoke and carbon monoxide detectors, and a working telephone. The changing table is observed to have wipes and several diapers size available. Highchairs are used for younger infants, and tables with small chairs for older children. All playpens are in good condition, and there are no toys or pillows inside. The mattress pads are the exact size and have a fitted sheet. Cots are provided to older children. LPA informed the staff that no toys or pillows are allowed in the infants' crib or playpens. All unused electrical outlets have a child-proof cover. Poisons, detergents, and cleaning compounds are made inaccessible to children. The backyard play structures are age-appropriate, in good condition, and free of loose parts. There are no bodies of water in the facility. Per Helper, there were no firearms or weapons on the premises. LPA observed no baby walkers or any similar items in the daycare. There is a pet dog in the home. Per Helper, the dog has up-to-date vaccination. Helper understood that smoking is prohibited in family child care homes.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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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Document Has Been Signed on 04/27/2022 01:19 PM - It Cannot Be Edited

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: 04/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(b)(1)

Staffing Ratio and Capacity

(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (1) Four infants; or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee/facility did not comply with the section cited above in 6 out of 11 children were infants, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2022
	Plan of Correction
1 2 3 4	The Licensee will reduce her capacity to meet the license requirements for a large license. For 12 children, no more than 4 infants (new born to 2 years) and 8 Preschoolers. Or 14 children, no more than 3 infants, 2 school-age children (one at least age 6, one enrolled in and attending Kindergarten.)

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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: PORTILLO, JESSICA J.	FACILITY NUMBER: 414004462
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview, the helper could not provide a record of the fire & earthquake drills and stated that since she started working in February 2021, the facility has not conducted any drills. Not conducting fire and earthquake drills poses/posed a potential health, safety, or personal rights risk to persons in care.
	POC Due Date: 05/13/2022
	Plan of Correction
1 2 3 4	The helper will discuss with Licensee and set up a reminder to conduct the drills at least every six months and document them properly.

Type B

Section Cited

CCR

102370(d)(1)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on the interview, and record review, one of the helpers, did not comply with the section cited above as the helper did not complete the clearance process. Although the helper submitted a livescan, the fingerprint clearance process was not completed. Not having a criminal record clearance poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2022
	Plan of Correction
1 2 3 4	The Licensee must ensure that all employee has criminal record clearance prior to their first day at the daycare. Helper states she will not be present at the daycare tomorrow or any day after that until the fingerprint clearance is finalized and follow-up with Guardian.

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: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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: PORTILLO, JESSICA J.	FACILITY NUMBER: 414004462
	VISIT DATE: 04/27/2022

NARRATIVE

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The helper stated since she started working in February 2021, the facility has not conducted fire and Earthquake drills and was not able to provide any document or log of any drill. The facility provides lunch and morning & afternoon snacks.
At 10:40 am, LPA reviewed records of all children present. Based on records review, it was found that 6 out of 11 children present at the daycare today were infants.
The facility has records for children in care, including immunization records. Each child has a complete emergency information card with the child's full name, telephone number, and location of a parent or authorized representative to be contacted in an emergency. The name and telephone number of the child's physician and the parent's authorization for the Licensee to consent to emergency medical care are on their respective file. Helper Pediatric CPR/First Aid is valid. The facility has posted all the required forms, such as facility License, Notification of Parent's Rights, Earthquake Preparedness checklist, and Notification of Personal Rights.
LPA discussed the safe sleep regulations with the Licensees and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Staff was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA reviewed AB 1207 with the staff. Staff was reminded about the Provider Information Notices (PINs) on the CCLD website. staff was informed 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. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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: PORTILLO, JESSICA J.	FACILITY NUMBER: 414004462
	VISIT DATE: 04/27/2022

NARRATIVE

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LPA encouraged the staff to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The staff can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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

The helper is advised to provide a copy of the Evaluation Report and the Type "A" Deficiency cited to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. This report will be maintained in the facility file and made available for public review three years after the thirty-day posting requirement has been met. This report and rights to comment and appeal have been discussed with staff. The report was reviewed and signed by staff Alison Meier. Today's report, 4/27/2022, and site visit notice will be sent to Alison Meier and Licensee's email on 4/27/2022. Confirmation of receipt is required, and a site visit notice must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

LIC809 (FAS) - (06/04)

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