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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409291
Report Date: 07/15/2019
Date Signed: 07/16/2019 10:03:54 AM

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:GARCIA, JENNYFACILITY NUMBER:
434409291
ADMINISTRATOR:GARCIA, JENNYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 802-5520
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY:14CENSUS: 14DATE:
07/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jenny GarciaTIME COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Shannel Reed and Licensing Program Manager Sandy Knight conducted an unannounced annual/ random inspection to the home today. LPA met with Licensee, Jenny Garcia, and explained the nature of today's visit. There were 14 daycare children present (four infants, 8 Preschoolers, and two school aged, including the licensee’s 9 year old son) during this visit. The Licensee's 12-year-old son was also present. The Licensee is currently out of ratio due to four infants being cared for at one time during today's visit. The Licensee stated that the only adults that reside in the home are the Licensee, and her spouse, her adult daughter and assistant/ helper, with her two minor sons. All adults have fingerprint clearance. LPA observed that the Licensee's CPR/First Aid card is current and expires on 12/31/20.
LPA and LPM toured the indoor and outdoor areas of the home during today's visit. LPA and LPM observed the required posted documents. The Licensee has a working telephone in the home. LPA and LPM observed sufficient materials and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA and LPM observed barricaded stairs in the home and a barricaded fireplace. Off limit areas inside the home: Entire second floor (master bedroom/bathroom, three additional bedrooms and an additional bathroom) and bedroom 2 on the first/ entry level. Off limit areas outside the home: The garage and fenced open area in the back yard.
LPA and LPM observed a fully charged 3A40BC fire extinguisher and operational smoke and carbon monoxide detectors. Licensee stated that there are no firearms or other dangerous weapons in the home. Sharps, medications, detergents, and cleaning compounds are inaccessible to children.

A review of Staff records indicates that all persons that require a caregiver background check have received criminal record and child abuse index clearance or exemption. LPA informed Licensee of the applicable civil penalties for any adult who has not received fingerprint clearances, is not associated to the license and who comes in contact with or provides care and supervision to the children.

REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 07/15/19):
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019
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 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: GARCIA, JENNY
FACILITY NUMBER: 434409291
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/16/2019
Section Cited
CCR
102416.5(d)
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Staffing Ratio and Capacity.For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:
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The Licensee shall notify parents that only three (3) infants can be in care at a time and shall create a plan detailing how she will ensure that the regulation for Staffing Ratio and Capacity is observed at all times, by the POC Due date of July 16, 2019.

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(1) Twelve children, no more than four of whom may be infants; or (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.
This requirement is not met as evidenced by: LPA observed that the Licensee had four infants, 8 preschoolers and two school agers in care which exceeds the maximum infant capacity for a Large Family Child Care home. This is an immediate risk to the children in care.

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AB633 Parent Notification is required. According to AB 633, all parents of children currently enrolled and any future children being enrolled for the next 12 months must be provided with this report which contains this Type A deficiency.
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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: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019
LIC809 (FAS) - (06/04)
Page: 3 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: GARCIA, JENNY
FACILITY NUMBER: 434409291
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2019
Section Cited
HSC
1596.8662(b)
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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.
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The Licensee shall ensure that her current Assistant, and any other Assitants that help with the daycare shall complete the Mandated Reporter training (AB1207) and shall submit a copy of the certificate of completion to LPA by the POC due date of August 30, 2019.
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This requirement is not met as evidenced by: LPA observed that the Licensee’s Assistant, Mirtha Martinez, has not completed the required Mandated Reporter training (AB1207) as of July 15, 2019. This is a potential risk to the children in care and a deficiency to the Health and Safety regulations.
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Type B
08/15/2019
Section Cited
CCR
102417(g)(7)
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Operation of a Family Child Care Home. An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization
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The Licensee shall work with parents to complete and sign the Identification and Emergency Contact information (LIC700) for each child currently missing the completed forms and shall ensure that any newly enrolled children have this form completed prior to their first day in care. The Licensee shall submit proof of completion of the
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for the licensee or registrant to consent to emergency medical care.
This requirement is not met as evidenced by: LPA and LPM observed that five of the fourteen files reviewed do not have complete Identification and Emergency Contact information (LIC700) on file. This is a potential risk to the children in care.
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missing information and a plan to ensure that this information is completed prior to the childs first day in care by the POC Due date of 08/15/19.
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: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019
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: GARCIA, JENNY
FACILITY NUMBER: 434409291
VISIT DATE: 07/15/2019
NARRATIVE
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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 07/15/19):
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.

During a review of 14 children's files LPA and LPM observed that five children have incomplete I.D. and Emergency Information forms (LIC700).
LPA reviewed the Licensee’s documentation. LPA observed that the Licensee has completed the required Mandated Reporter training (AB1207), however, her Assistant, Mirtha Martinez has not. LPA observed the required immunization's against Pertussis, Measles and an Influenza decline statement on file for the Licensee and Assistant, Mirtha Martinez. Supervision of children was discussed with the Licensee and she does transport children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.
LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov.
The Mandated Reporter Training (AB1207) can be completed at the website listed. http://www.mandatedreporterca.com. LPA discussed and provided Lead Safety Information (AB2370) and Safe Sleep information with the Licensee.

Title 22 deficiency were cited on the subsequent pages of this report.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4