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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434403990
Report Date: 08/07/2019
Date Signed: 08/07/2019 04:43:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:THOMPSON, MARIELAFACILITY NUMBER:
434403990
ADMINISTRATOR:MARIELA THOMPSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 225-1479
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:14CENSUS: 0DATE:
08/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Thompson, MarielaTIME COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Almaraz, Araceli conducted an annual random inspection. LPA met with Licensee, Thompson, Mariela and explained the nature of today's inspection. Present during the inspection was the licensee and assistant Falcon, Nelly. There were six children present, one infant and five toddlers. The hours of operation of the day-care are 7:30 AM to 5:30 PM, Monday through Friday. There is one adult residing in the home; licensee and minor son Licensee and assistant have CPR and First Aid, which have an expiration date of 09/2020. LPA reviewed seven children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. LPA observed that the Licensee and assistant have record of MMR & Tdap vaccinations as well for the flu vaccine. LPA observed a working smoke/carbon monoxide detector, 2A10BC fire extinguisher and no bodies of water were observed. LPA did observe a heater in a small closet in the home. LPA and licensee discussed, as an extra precaution placing a safety door knob for that door and all other rooms meant to be inaccessible. LPA placed knob on heater closet door during visit. LPA observed a barricaded fireplace.

LPA inspected the indoor and outdoor areas of the home today. Off limit areas in the home are as follows; master bedroom/bathroom, three bedrooms, living room and garage. Off limit areas outside the home are as follows: The right side of the yard. The right side does have a fence to prevent some access, the fence does not fully extend. There is an air-conditioning unit in that area and tools. LPA and licensee discussed air conditioning unit and other items in the back yard that has access to the children in care. Licensee understands the potential risk of the unit and would like to minimize any risks it may cause. The front yard is safety complaint and backyard is fully fenced.

Supervision of the children was discussed; Licensee understands a cleared adult must be present in the home during day care hours, the children must be supervised at all times and the capacity options/ratio requirements. The Licensee states that there is currently no transporting of children and understands not to leave children in a car unattended.
Report Continued on Page 2*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: THOMPSON, MARIELA
FACILITY NUMBER: 434403990
VISIT DATE: 08/07/2019
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Medication, cleaning products and similar items are stored inaccessible to children. Poisons shall be locked. LPA observed a current roster, a current fire disaster/earthquake drills last log 07/2019. Licensee states that there are no weapons in the home. Licensee has no pets. Licensee has day care insurance. Licensee and assistant have completed Mandated Reporter Training on 02/2018, licensee understands training is to be completed every two years.

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

A review of staff records on 08/05/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates



There is one Type B deficiency during today’s inspection. The following Type B deficiency noted on the attached page (809-D): Appeal rights provided to the Licensee prior to the conclusion of today's inspection.

LPA conducted an exit interview with the Licensee and advised the licensee of the pending Department regulation update re: safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information. LPA discussed the requirements of AB633 to Licensee.

NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

Report Continued From Page 1*****

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: THOMPSON, MARIELA
FACILITY NUMBER: 434403990
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2019
Section Cited
CCR
102417(g)
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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: This requirement was not met as evidenced by LPA observed licensee failed to meet this requirement by an air conditioning unit and tools that does not fully prevent access to the children in care.
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Licensee will extend fence fully to back fence to prevent access to air conditioning unit and tool area. Licensee send proof of correction via fax, email, mail or text photo to LPA on or before 08/28/2019. If needed LPA will return to confirm fence is suffiicient to prevent access.
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This poses a potential risk to the health and safety to the children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
LIC809 (FAS) - (06/04)
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