434410139-6-26-2019-07-CC-SCRL-BDHUBZ-20190626152711

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410139
Report Date: 06/26/2019
Date Signed: 06/26/2019 03:27:18 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:	DE PIEROLA, ERIKA		FACILITY NUMBER:	434410139
ADMINISTRATOR:	ERIKA DE PIEROLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 504-5635
CITY:	CAMPBELL	STATE: CA	ZIP CODE:	95008
CAPACITY:	14	CENSUS: 9	DATE:	06/26/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Erika De Pierola		TIME COMPLETED:	03:30 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	Licensing Program Analyst (LPA), Stephanie Rangel, conducted an annual random inspection. Present in the home during the inspection were licensee, husband and 9 daycare children including 3 infants, and 6 preschool aged. Days and hours of operation are Monday thru Friday from 7 AM to 6:00 PM. There are two adults living in the home: licensee and her husband with their child aged 12 years old. Licensee and husband's CPR and First Aid certification expire 03/03/2020. LPA toured the home. The home is clean and orderly. LPA observed the following: fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and barricaded fireplace. Off limit areas in the home: master bedroom, master bathroom, son and daughter's bedroom. Off limit areas outside the home are both gated side yards. Licensee stated that there are no weapons in the home. Cleaning compounds, medications, sharp objects, and other similar items are stored inaccessible to the children. The last fire drill was conducted 12/2018. The home has a working telephone which is (408) 369-1806. Incidental Medical Services (IMS) policy was discussed. 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. 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. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 06/26/2019):

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C Rangel	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

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: DE PIEROLA, ERIKA	FACILITY NUMBER: 434410139
	VISIT DATE: 06/26/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 06/26/2019):

Nine children's files were reviewed during today's inspection. A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Periodic information releases accessible by signing up at: www.myccl.ca.gov

Effect of Lead Exposure handout dated 1/20/19 given during today’s inspection. Per Assembly Bill (AB 2370), written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians.

LPA conducted an exit interview with the Licensee prior to the conclusion of today's inspection and advised the Licensee of the required "mandated reporter" training for Assembly Bill, AB 1207 requirement for Child Care Providers that all staff must complete within 90 days of commencing employment at the Facility. The website for the online training is: http://www.mandatedreporterca.com

As a result of this inspection, deficiency cited on the following pages:

Appeal rights were reviewed and printed.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C Rangel	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

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: DE PIEROLA, ERIKA	FACILITY NUMBER: 434410139
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/26/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/31/2019 Section Cited HSC 1596.8662(b)(1)	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 provided pursuant to paragraphs (2) and (3) of subdivision (a) and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.	1 2 3 4 5 6 7	Licensee stated the she and her assistant will complete the mandated reporter training for AB 1207 and submit proof of completion of training to CCL by POC due date of 7/31/19
	8 9 10 11 12 13 14	This requirement was not met as evidenced by the Licensee and assistant not being able to show proof of completion of mandated reporter training. 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
	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: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C Rangel	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

LIC809 (FAS) - (06/04)

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