434407809-8-7-2019-07-CC-SYIP-BETVFN-20190807162411

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434407809
Report Date: 08/07/2019
Date Signed: 08/07/2019 04:25:20 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:	THOM, MARY & PETRIE, MEREDITH		FACILITY NUMBER:	434407809
ADMINISTRATOR:	THOM & PETRIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 778-3515
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	14	CENSUS: 12	DATE:	08/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Mary Thom and Meredith Petrie		TIME COMPLETED:	03:40 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) Samantha Yip conducted an unannounced annual random inspection. LPA met with Licensees Mary Thom and Meredith Petrie and explained the reason for the inspection. Present during the inspection were 12 children, whom 1 was infant age. Adults present during today's inspection are fingerprint cleared. License, Notification of Parent's Rights and Emergency Disaster Plan were observed to posted. There is a working phone in the home. Licensees do not carry daycare insurance. LPA toured the inside and outside of the facility with Licensee Meredith Petrie. The home was observed to be clean. Licensee uses room adjacent to the garage. The off-limit area of the home are the main home, front yard, and the right side of the backyard. There are no stairs or fireplace in the daycare area. Sharp or other things that are dangerous to children were observed to be stored inaccessible to children in care. LPA reminded Licensees that all disinfectants and cleaning supplies should be stored inaccessible to the children in care. Furniture and equipment, such as tables, chairs, high chairs, and napping mats, were observed to be in good conditions. Restroom for children's use was observed to be clean and sanitary. LPA observed there is sufficient amount of toys for the children in care. LPA did not observe any baby walkers or bouncers to be in use during today's inspection. Licensees understand that baby walkers and bouncers are not permitted in the home. LPA observed a fully charged fire extinguisher, functioning carbon monoxide and smoke detector. The last fire/disaster drill was conducted on 07/24/2019. Licensee Meredith stated there is no weapons stored in the home. ----------------continues on 809 dated 08/07/2019 page 2-------------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
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

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: THOM, MARY & PETRIE, MEREDITH	FACILITY NUMBER: 434407809
	VISIT DATE: 08/07/2019

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

----------continuation of 809 dated 08/07/2019 page 1------------------------------------------

The backyard is used for children's use and is fenced. Play equipment and toys were in good condition. There is play structure outside, which is anchored to the ground. There is a pool and a hot tub in the backyard, which has a pool cover that holds the weight of an adult. LPA did not observe any other bodies water during today's inspection.

Licensees do not transport children at this time, but understands that no child shall be left alone and unattended in parked vehicles. Licensees also understands that children's personal rights should not be violated; including no corporal punishment.

Facility roster was reviewed and a copy was obtained. 10 children's files were reviewed during today's inspection. The records reviewed included but not limited to consent for emergency treatment.

Licensees' CPR/1st Aid expires on 07/17/2020. Licensees completed Mandated Reporter Training on 11/2/2019. LPA reminded Licensees that Mandated Reporter Training needs to be renewed every 2 years.

The adults living the home are Licensees, Licensee's Mary spouse and her three adult children. All adults living the home have cleared criminal records, child abuse index clearance, and TB clearance. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, 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.

----------------continues on 809 dated 08/07/2019 page 3--------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
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: THOM, MARY & PETRIE, MEREDITH	FACILITY NUMBER: 434407809
	VISIT DATE: 08/07/2019

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

-------------------continuation of 809 dated 08/07/2019 page 2---------------------------------

Licensee Meredith stated that she currently does not have any children in care who requires IMS services. Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Home Section 102417. 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.

LPA also reviewed Safe Sleep information. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

In areas that were evaluated, no deficiencies were cited. An exit interview was conducted, where this report was discussed and provided to Licensee Meredith Petrie.

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

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
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: 3 of 3