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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410997
Report Date: 08/22/2019
Date Signed: 08/22/2019 02:00:25 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:DUFFIN, KRISTYFACILITY NUMBER:
434410997
ADMINISTRATOR:DUFFIN, KRISTYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 506-8532
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY:14CENSUS: 7DATE:
08/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Duffin, Kristin TIME COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Almaraz conducted an annual random inspection. LPA Almaraz met with Licensee, Duffin, Kristen and explained the nature of today's inspection. Present during the inspection was Licensee Duffin. There were seven children present, two school age and five preschool age. One child is visiting with parent to see if child will adust and be enrolled The hours of operation of the day-care are 9:30 AM to 12:30 PM, Monday through Thursday. There are three adults residing in the home: Licensee Duffin, spouse Duffin, Doran and son Duffin, Kristopher, and two minor children. Licensee Duffin has CPR and First Aid, which has an expiration date of 04/2021. LPA Almaraz observed a current roster, LPA Almaraz reviewed four children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. LPA Almaraz and Licensee Duffin discussed children had sufficient evidence of updated immunization's however, Licensee Almaraz will need to record immunization records on California School Immunization Record, PM 286 (6/95). LPA Almaraz observed that Licensee Duffin has record of MMR & Tdap vaccinations as well as the opt out form for the flu vaccine. Licensee Duffin completed Mandated Reporter Training on 01/2019, licensee Duffin understands training is to be completed every two years. Licensee Duffin has no day care insurance.

Medication, cleaning products and similar items are stored inaccessible to children. Poisons must be locked . Licensee states that there are no weapons in the home. Licensee has no pets. No bodies of water were observed.
Report Continued on Page 2*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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: DUFFIN, KRISTY
FACILITY NUMBER: 434410997
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2019
Section Cited
CCR
102417(g)
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Operation of a Family Child Care Home :The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:. This requirement was failed to be met by licensee Duffin as evidenced by LPA Almaraz observed two airconditioning units with access to the chidlren in care. This causes a potential risk to the health and safety of the children in care.
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Licensee Duffin will barricade two airconditioning units and submit photo with proof via fax, mail, email pdf and/or text photo on or before 09/05/2019.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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: DUFFIN, KRISTY
FACILITY NUMBER: 434410997
VISIT DATE: 08/22/2019
NARRATIVE
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LPA Almaraz observed a working smoke/carbon monoxide detector, 3A40BC fire extinguisher. LPA Almaraz did not observe any heaters in the home. LPA Almaraz observed a fireplace. Licensee Duffin has a waiver on file that fire place is not to be used during day care hours or when children are present. LPA Almaraz observed that Licensee Duffin was in compliance of the waiver. Licensee Duffin states the gas has been turned off by PG&E as an additional safety precaution. Licensee Duffin has a current fire disaster/earthquake drills last log 03/2019.

LPA Alamraz inspected the indoor and outdoor areas of the home today. Off limit areas in the home are as follows; Upstairs, locked office, front closet, locked laundry room that leads to garage. Licensee Duffin states there was a gate to prevent access to upstairs currently, visual and verbal supervision is used to prevent access. LPA Almaraz and Licensee Duffin discussed putting a gate up again as an additional precaution. Licensee Duffin states a gate will be put up in one week.

Off limit areas outside the home are as follows: The right side of the yard. There is currently no gate to prevent access to this area. LPA Almaraz observed this area has two air-conditioning units that are not barricaded. LPA Almaraz and Licensee Duffin discussed the two air conditioning units . Licensee Duffin understands the potential risk of the units and would like to minimize any risks they may cause. The front yard is safety compliant and backyard is fully fenced.

Supervision of the children was discussed; the Licensee understands a cleared adult must be present in the home during day care hours. Licensees understand that the children must be supervised at all times. The Licensee understands the capacity options and ratio requirements. Licensee understands not to leave children in the car unattended. The Licensee states that there is no transporting of children currently.

Report Continued on Page 3*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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: DUFFIN, KRISTY
FACILITY NUMBER: 434410997
VISIT DATE: 08/22/2019
NARRATIVE
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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

A review of staff records on 08/20/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA Almaraz reminded Licensee Duffin 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.http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates


The following Type B deficiency noted on the attached page (809-D): Appeal rights provided to the Licensee prior to the conclusion of today's inspection.

LPA Almaraz conducted an exit interview with the Licensee Duffin and advised the licensee of the pending Department regulation update re: safe sleep for infant children. LPA Almaraz referred the Licensee to the Department website: www.ccld.ca.gov for additional information. LPA discussed the requirements of AB633 to Licensee.

NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

Final Page of the Report Continued From Page 2****

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4