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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408402
Report Date: 11/07/2019
Date Signed: 11/07/2019 01:45:52 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:PITT, GLADYSFACILITY NUMBER:
434408402
ADMINISTRATOR:PITT, GLADYSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 985-1012
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:14CENSUS: 6DATE:
11/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Gladys PittTIME COMPLETED:
01:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tuoc Doan conducted an unannounced Annual Inspection of the Family Day Care Home. LPA met with Licensee Gladys Pitt and explained to her the purpose of the inspection. Present were six children in care, of whom one was under two years old.

The physical plant was inspected. Off Limit Areas inside the home are all three bedrooms and the Master bathroom. LPA observed that the backyard is undergoing renovations. Licensee stated that the renovation is expected to be complete in January 2020. LPA discussed with Licensee regarding supervision of the children to ensure that they do not go to the backyard.

The home has a detached Garage in the back of the house. There were no bodies of water observed. The home maintains telephone service. Licensee understands that baby walkers are not allowed to be used in a Family Day Care Home. Licensee stated that there were no weapons stored on the premises. Disinfectants, cleaning solutions, sharps, and other items that are dangerous to children in care were stored out of reach of the children. LPA reminded Licensee that poison needs to be locked up.

Smoke and Carbon Monoxide Detectors were tested and proved to be functioning. Facility's Fire and Earthquake drills log record that the last drills were conducted in July 2019. Licensee's file was reviewed, which included records of Criminal Record and Child Abuse Index Clearances, and TB clearance. Licensee's Pediatric CPR/First Aid Certification expires on 04/29/2021.

Licensee stated that she has five small size pet dogs and two ducks. Currently, the dogs are kept in the Master Bedroom and the ducks are kept in the back yard during day care hours. Per Licensee, the dogs are up to date with vaccination.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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: PITT, GLADYS
FACILITY NUMBER: 434408402
VISIT DATE: 11/07/2019
NARRATIVE
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Adults who are over the age of 18 and reside in the home are Licensee, and Licensee's Mother, Spouse, and Son. They have Clearance for Criminal Record and Child Abuse Index Background Checks. 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. For an initial violation, civil penalty amounts to $100.00 per person, up to $500.00 per person. For a subsequent violation within a 12 month period, civil penalty amounts to $100.00 per person, up to a maximum of $3000.00 per person.

Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Adoption of new Laws, etc.

Beginning January 1, 2019 AB2370 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. Safe Sleep information was also provided to Licensee.

Incidental Medical Services (IMS) policy was discussed with Licensee. Licensee stated the currently she does not have any children in care who requires the administration of medication.
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.

In the areas that were evaluated, regulatory violations were observed at the time of the visit.
Exit Interview was conducted, where this report, the violations, plan of corrections, and appeal rights were reviewed with Licensee.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN ENTRANCE INTO THE HOUSE FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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: PITT, GLADYS
FACILITY NUMBER: 434408402
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2019
Section Cited

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OPERATION OF A FAMILY CHILD CARE HOME. The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.
This requirement is not met as evidenced by:
LPA observed flies in the home. There are small and large things cluttered on the floor
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of the Kitchen, obstructing pathway. Storage containers are placed on the Kitchen floor at level where the children were climbing on it, which increase the risk of falling. The wall power outlets near ground level do not have covers on. This poses a potential risk to the health and safety of children in care.
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Type B
11/15/2019
Section Cited

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HEALTH & SAFETY CODE: Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent [...], and the name and telephone number of the child's physician.
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Based on LPA's review of the roster and files for children in care, there are at least three children who are present during LPA's inspection but are not listed on the roster. This poses a potential risk to the health and safety of 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: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2019
LIC809 (FAS) - (06/04)
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