434407664-10-2-2019-07-CC-MMAR-BGKSX5-20191002141522

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434407664
Report Date: 10/02/2019
Date Signed: 10/02/2019 02:15:29 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:	GALSIM, MARIBEL		FACILITY NUMBER:	434407664
ADMINISTRATOR:	GALSIM, MARIBEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 528-7340
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY:	14	CENSUS: 8	DATE:	10/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Maribel Galsim		TIME COMPLETED:	02:30 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 10/02/19 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Annual/Random Inspection at Maribel Galsim's Family Day Care Home. LPA met with Licensee, Maribel and explained the purpose of today’s inspection. Present in the home were Licensee, two Helpers and eight (8) day care children (2 infants, 6 preschool age). Facility is in compliance with required ratios today. Children were napping and later engaged in various activities under the supervision of the Licensee and Helpers. Days and hours of operation are Monday - Friday from 7:00 AM - 6:00 PM. Adults over the age of 18 and residing in the home are the Licensee, Licensee's spouse, mother (Helper 1) , sister (Helper 2), son and his girlfriend. All adults have Criminal Background Check Clearances, TB clearance and signed Criminal Record Statements LIC508 on file with Licensing Office. LPA toured the indoor and outdoor areas of the home during today's inspection: INDOOR SPACE: In Use Areas: Family Room, Half Bathroom attached to Family Room. Licensee states she does not use the bedroom downstairs that was previously used area. Off Limit Areas: Kitchen, Bedroom downstairs, Entire Second floor, Living Room. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Furniture and equipment, such as cribs, mats, feeding chairs, and tables were age appropriate and in good condition. There were no baby walkers or bouncers observed on the premise during today’s inspection. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters in the home. There is no fireplace inside the home. There are stairs inside the home which were barricaded with child proof gate. LPA observed repair activity underway in the front yard. OUTDOOR SPACE: Off Limit Areas: Left and Right Side Yards, Pool area. There is a waiver on file for a fenced pool. LPA observed the pool has been filled with concrete and leveled up to the ground. Licensee states a City Inspection for the pool is scheduled on Oct 4, 2019. LPA asked Licensee to send to CCLD a copy of the inspection report. Licensee will also send an updated Facility Sketch for indoor and outdoor showing changes made to building and grounds. The outdoor space and play equipment were observed to be maintained in safe condition and free of hazards. The side yards are fenced and off limits. Continued on Page #2. Report dated 10/02/19

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

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: GALSIM, MARIBEL	FACILITY NUMBER: 434407664
	VISIT DATE: 10/02/2019

NARRATIVE

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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 comes 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.

Incidental Medical Services (IMS) policy was discussed. The Licensee stated that she currently does not have any children in care who requires IMS. 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.

Beginning January 1, 2019 AB 2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

In the areas that were evaluated, regulatory violations were observed. Exit Interview was conducted, where this report, the citations, plan of corrections, and appeal rights were reviewed and discussed with Licensee. Citations are issued on 809-D pages of this report. Licensee signed the report acknowledging receipt of documents. LPA reminded Licensee that failure to correct deficiencies by Plan of Correction Due Date may result in penalties of $100 per day per violation.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED NEAR THE FRONT ENTRANCE TO THE HOME FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

Page: 4 of 4

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: GALSIM, MARIBEL	FACILITY NUMBER: 434407664
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/02/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/02/2019 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home: If food is brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Per LPA's observation children bottles were not labeled. This poses a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
Type B 11/13/2019 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 […] and shall complete renewal […] every two years […]. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Based on today’s inspection, Helpers 1 & 2 do not have Mandated Reporter Training AB1207. Licensee stated that she was unaware of this requirement. This poses a potential risk to the children	8 9 10 11 12 13 14

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: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: GALSIM, MARIBEL	FACILITY NUMBER: 434407664
	VISIT DATE: 10/02/2019

NARRATIVE

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LPA observed a fully charged 2A10BC fire extinguisher in the kitchen and working smoke / carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. LPA reviewed a current Children Roster and Fire/Disaster Drill Log during today's inspection. Last fire/disaster drill was completed on 09/13/19. All required postings including but not limited to Parent Rights Poster, Facility License, Emergency Disaster Plan were observed posted on a wall in the Family Room. The Licensee states that she does not transport children. Licensee states that she supplies snacks and meals to the children. Food storage area was observed to be clean. Child cups, bowls and bottles were not labeled with child’s name. LPA discussed Healthy Beverages Act with the Licensee. Day care home appeared to be free of flies, other insects, and rodents during today’s inspection.

FILE REVIEW:
8 Children's files were reviewed and contained all required Licensing forms and records including but not limited to Receipt for Parents' Rights, Immunization record, Identification & Emergency Information, Consent for Medical Treatment, Parent Notification for Additional Children in Care, Affidavit Regarding Liability Insurance, Health History.
Licensee and Helpers files contained Criminal Record and Child Abuse Index Clearance, TB clearance, Statement Acknowledging Requirement to Report Suspected Child Abuse, Employee Rights, Immunizations for Measles, Pertussis, Flu. Licensee's and Helpers' certifications for CPR and First Aid are current and expire on 04/2021. Helpers 1 & 2 did not have required Mandated Reporter Training per AB1207.

LPA advised the Licensee of the required Mandated Reporter Training for Child Care Providers that all Licensees and employees are required to complete as of January 1, 2018. The website for the online training is: http://www.mandatedreporterca.com/training/childcare.htm.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during 80% of the operating hours of the day care and ensure that the children are supervised at all times. The Licensee understands her capacity options and that she cannot have more than 14 children in the home at any time with at least two qualified adults present. Licensee also understands that she must comply with the ratio and capacity requirements of the Small Family Child Care Home license whenever she or a qualified adult is alone with the children.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

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