434409291-6-30-2021-07-CC-AMOS-C4GLBZ-20210630083735

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434409291
Report Date: 06/29/2021
Date Signed: 06/30/2021 08:37:44 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, JENNY		FACILITY NUMBER:	434409291
ADMINISTRATOR:	GARCIA, JENNY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 802-5520
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	14	CENSUS: 9	DATE:	06/29/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Jenny Garcia		TIME COMPLETED:	04:15 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 0629//2021 at 2:00pm: Licensing Program Analysts (LPAs) Anna Morales and Pete Hernandez conducted an unannounced Annual/Required Inspection ( Tool Kit One) at Jenny Garcia's family Day Care Home. LPA met with Licensee, Jenny Garcia and explained the purpose of today’s inspection. Present in the home were Licensee, nine day care children (one infant, over 12 months old, five school age children and three preschoolers). Children were napping under the supervision of the Licensee. Days and hours of operation are Monday - Friday from 6:30 AM -6:00 PM. Adults over the age of 18 and residing in the home are the Licensee, her spouse, her assistant, daughter. Licensee's two minor children (over the age of ten) also reside at the home. All adults have Criminal Background Check Clearances, signed Criminal Record Statements LIC508 on file with Licensing Office. LPA's did not observe a TB clearance for the assistant in file. LPA toured the indoor and outdoor areas of the home during today's inspection: The home is a two story home. LPA observed barricaded stairs during today's inspection. Off limit area inside the home (1st level): garage. 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's observed a fully charged 3A40BC fire extinguisher, pull alarm 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. The Licensee has a working telephone in the home. LPA's observed sufficient materials, toys, and play equipment for the day care children in the home. Furniture and equipment, such as mats, feeding chairs, and tables were age appropriate and in good condition. The home is clean, orderly, and safe for the day care children. LPA's did not observe any wall heaters in the home. Page 1

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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: GARCIA, JENNY	FACILITY NUMBER: 434409291
	VISIT DATE: 06/29/2021

NARRATIVE

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LPA's did not observe any bodies of water on the property. Licensee understands that all pools, spas, hot tubs, fish ponds, or similar bodies of water shall be covered or fenced as specified in title 22 regulations to be inaccessible to children. Licensee has two dogs however, they don't mingle with the children while in care. Licensee stated that she transports children and is aware that she is not allowed to leave the children without supervision at any time.

LPA's reviewed three of nine Emergency Information Cards(LIC700) were complete and updated. 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.
Licensee does not have current Mandated Reporter Certificate. The last Mandated Reporter Certificate expired for Licensee on 7/19/2020. LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with applicant Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed atwww.mandatedreporterca.com.

Licensee has a current CPR and First Aid card that expires on 2/7/2023

Website for resource information: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates
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 (page 2)

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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: GARCIA, JENNY	FACILITY NUMBER: 434409291
	VISIT DATE: 06/29/2021

NARRATIVE

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Continued from 809c page 2.

Deficiencies are being cited based on the LPA's observations, interviews conducted and records reviewed in accordance with the California Code of Regulations Title 22.

LPA conducted an exit interview with the Licensee . LPA discussed and left a copy of Pin 20-24-CCP, RECENTLY APPROVED SAFE SLEEP REGULATIONS IN EFFECT. Discussed that all INFANTS UP TO 12 MONTHS OF AGE MUST HAVE AN INDIVIDUAL INFANT SLEEPING PLAN (LIC9227) OF FILE, WHICH WILL DOCUMENT THE INFANTS SLEEPING HABITS, USUAL SLEEPING ENVIRONMENT, AND THE INFANT ROLLING ABILITIES.

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

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

LIC809 (FAS) - (06/04)

Page: 5 of 5

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: 06/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/29/2021 Section Cited	1 2 3 4 5 6 7	102369(b)(9) Application for License. Licensees and any adult in the home, shall provide evidence of a current tuberculosis clearance, performed and signed by a physician not more than one year prior to or seven days after first day of employment.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by S1( assistant) does not have a TB test on file. This poses a potential risk Health, Safety Personal Rights risk to children in care.	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: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: 06/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/15/2021 Section Cited	1 2 3 4 5 6 7	MANDATED REPORTER TRAINING. [...] a person who, on January 1, 2018, is a licensed child care provider [...] shall complete the mandated reporter training provided [...] and shall complete renewal mandated reporter training every two years
	8 9 10 11 12 13 14	LPA observed that Licensee did have not completed the Mandated Reporter Training.:It expired on 7/19/2020 .This poses a potential risk to children's health and safety of children in care.	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: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

LIC809 (FAS) - (06/04)

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