434406545-1-22-2020-07-CC-SRED-BL3SV8-20200122131220

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434406545
Report Date: 01/22/2020
Date Signed: 01/22/2020 01:12:27 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:	MC CAUL, PATTY		FACILITY NUMBER:	434406545
ADMINISTRATOR:	MC CAUL, PATTY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 492-1651
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95054
CAPACITY:	14	CENSUS: 6	DATE:	01/22/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Patty Mc Caul		TIME COMPLETED:	01:20 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) Shannel Reed met with Patty Mc Caul, Licensee, for an unannounced annual/random inspection. LPA observed the Licensee and an Assistant, Jonafe Buenaventura, with six (6) (two (2) infants and four (4) preschool aged) napping day care children in the home during today's inspection. The adults that reside in the home are the Licensee and her spouse. LPA observed a barricaded staircase in the home. Days and hours of operation are Monday - Friday from 7:00 AM to 6:00 PM. LPA reviewed and obtained a current Child Care Facility Roster and observed a current Fire/Disaster drill log during today's inspection. The last fire drill was conducted on 12/02/19. LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee’s has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA observed a barricaded fire place. Off limit areas inside Licensee's home: Entire upstairs (four bedrooms & two bathrooms) and the attached garage. Off limit areas outside the home: left & right side sections of the backyard, barricaded air conditioner unit, and locked jacuzzi tub. LPA reviewed the Licensee and Assistant’s file information. The Licensee's certifications for CPR and First Aid are current and expire 10/19/21. LPA observed the Licensee and her Assistant’s required Immunization’s against Measles, Pertussis and Influenza (or opt out statement) on file. However, the Licensee and her assistant have not completed the required Mandated Reporter Training (AB1207). LPA advised the Licensee that any adult that comes in contact with or provided care and supervision to the children, need to have the required immunization's and the require Mandated Reporter Training certificate on file. LPA reviewed six (6) enrolled children’s files. All files have the required documentation and immunization's. REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 01/21/20):

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MC CAUL, PATTY	FACILITY NUMBER: 434406545
	VISIT DATE: 01/22/2020

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 01/21/20):
LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee states there are no weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. The Licensee states that she does not administer medication to children.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options. The Licensee states that she does not transport children.

The Licensee will submit an Updated Application (LIC279) and Emergency Disaster Plan (LIC610A) to CCL as changes have occurred since originally submitted.

LPA provided the Mandated Reporter Training (AB1207) website, http://www.mandatedreporterca.com, and information so that the Licensee, her assistant and any applicable staff can complete the required training. LPA also provided Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov. LPA discussed and provided Safe Sleep and Lead Safety Information (AB2370) with the Licensee.

A Type B Title 22 deficiency was cited during today’s inspection.

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

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MC CAUL, PATTY	FACILITY NUMBER: 434406545
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/22/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/06/2020 Section Cited	1 2 3 4 5 6 7	On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: LPA observed that Licensee, her Assistant and any additional helpers have not completed the required Mandated Reporter training (AB1207) as of January 22, 2020. Licensee understands this is a potential risk to the children in care and a deficiency to the Health and Safety regulations.	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: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

LIC809 (FAS) - (06/04)

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