434410139-2-26-2020-07-CC-SYIP-BM6W42-20200226155649

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410139
Report Date: 02/26/2020
Date Signed: 02/26/2020 03:57:00 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: 12	DATE:	02/26/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:59 PM
MET WITH:	Erika and Carlos De Pierola		TIME COMPLETED:	04:00 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 Required-1 Year inspection. LPA met with Licensee Erika De Pierola and her spouse Carlos De Pierola. Present during the inspection were 12 children, whom three (3) were infant age. Also, present was Licensee's minor child. License, Notification of Parent's Rights, and Emergency Disaster Plan were posted. There is working phone in the home. LPA toured in the inside and outside of the home with Licensee Erika. The off-limit areas of the home are Room 1, 4, bathroom in Room 4, garage, the left and right side of the home. There are no stairs in the home. There is a fireplace in the home, which is barricaded. Disinfectant, cleaning supplies, and other items that are dangerous to children were observed to be stored inaccessible to children. Furniture and equipment, such as high chairs, tables, chairs, play yard, and napping cots, were observed to be in good condition. LPA observed that there is sufficient amount of toys for children. Restroom for children was observed to be clean and in functioning conditions. LPA observed a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 01/2020. Licensee stated that there are no weapons, such as firearms, stored on the premise. The backyard is used. Licensee stated that her husband is currently fixing the fence on back right side. LPA reminded Licensee to put any tools and garden tools away before children use the backyard. LPA also observed that there is gap in the fence that lead to their neighbor on the right side. LPA discussed with Licensee about supervision of children and plans for the fence. There is a bird water bath in the front of the home, which was ------------------------continues on 809 dated 02/26/2020 page 2--------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020

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: 02/26/2020

NARRATIVE

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----------------------continuation of 809 dated 02/26/2020 page 1----------------------------------

empty. There were no bodies of water observed during today's inspection.

Licensee does not currently transport children, but understands that children cannot be left alone and unattended in parked vehicles. Licensee stated that she currently does not have any children in care who requires Incidental Medical Services.

A copy of the facility roster was obtained. 11 children's files were reviewed during today's inspection. The records reviewed include but not limited to Consent for Medical Treatment and parent's rights. LPA reminded Licensee to check that all forms are signed by parent.

Licensee and her spouse have a valid CPR/1st Aid, which expires on 03/03/2020. Both Licensee and her spouse's Mandated Reporter Training certificate and immunization records for measles and pertussis are on file. LPA reminded Licensee that the Mandated Reporter Training requires renewal every two (2) years.

Adults living in the home are Licensee and her spouse. All adults living in the home have cleared criminal record clearance, child abuse index, and TB test results. 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.

LPA discussed and provided Licensee with 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 have been cited. An exit interview was conducted, where this report was discussed and provided to Licensee Erika and Carlos De Pierola. 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: 02/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020

LIC809 (FAS) - (06/04)

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