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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411750
Report Date: 08/29/2019
Date Signed: 08/29/2019 01:56:05 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:BYBEE, STEPHANIEFACILITY NUMBER:
434411750
ADMINISTRATOR:BYBEE, STEPHANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 677-3877
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY:14CENSUS: 9DATE:
08/29/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Bybee, StephanieTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Almaraz, Araceli conducted an annual random inspection. LPA Almaraz met with Licensee, Bybee, Stephanie and explained the nature of today's inspection. Present during the inspection was the Licensee Bybee and Assistant Hedayat, Sanam. There were nine children present, three infants and six preschoolers. The hours of operation of the day-care are 7 AM to 6 PM, Monday through Friday. There is one adult residing in the home; Licensee Bybee and two minor children.

Licensee Byebee has CPR and First Aid, which has an expiration date of 02/17/2020. Assistant Hedayat has CPR and First Aid, which has an expiration date of 06/09/2020. LPA Almaraz observed that the Licensee Bybee and Assistant Hedayat have record of MMR & Tdap vaccinations as well as the opt out form for the flu vaccine. LPA Almaraz reviewed five 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 observed a current roster. Licensee Bybee has day care insurance. Licensee Byebee has not completed Mandated Reporter Training, LPA Almaraz and Licensee Byebee discussed training is to be completed every two years.

LPA Almaraz observed a current fire disaster/earthquake drills last log 07/15/2019. LPA Almaraz observed a working smoke/carbon monoxide detector, 2A10BC fire extinguisher last serviced 02/07/2019. LPA Almaraz did not observe any heaters in the home. LPA Almaraz observed a barricaded fireplace.
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: 08/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019
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: BYBEE, STEPHANIE
FACILITY NUMBER: 434411750
VISIT DATE: 08/29/2019
NARRATIVE
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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.

Website for provider resources: 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 Bybee prior to the conclusion of today's inspection.

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


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

Report Coninuted from Page 3*****

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

DATE: 08/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019
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: BYBEE, STEPHANIE
FACILITY NUMBER: 434411750
VISIT DATE: 08/29/2019
NARRATIVE
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LPA Almaraz inspected the indoor and outdoor areas of the home today. Off limit areas in the home are as follows; Upstairs and one bedroom downstairs. The upstairs is gated off and the bedroom is locked, preventing access to the children in care. LPA Almaraz observed two fish tanks, placed high up, inaccessible to the children in care and with lids.

Off limit areas outside the home are as follows: The right side and left side of the backyard. Both areas are sectioned off appropriately, preventing access to the children in care. The right side is fenced and the left side is gated. The LPA Almaraz observed an air-conditioning unit on the left side of the yard in an accessible area. LPA Almaraz and Licensee Bybee discussed the potential risk of air-conditioning units. The air-conditioning unit is about 4 feet tall, taller than the current children in care and its sides present no risk. As a safety precaution Licensee Bybee stated the unit will be barricaded. The front yard is safety compliant and backyard is fully fenced. Licensee Bybee states that there are no weapons in the home. . LPA Almaraz did not observe any bodies of water outside the home. Medication, cleaning products and similar items are stored inaccessible to children. Poisons must be locked. Licensee Byebee has no pets.

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

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: 08/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019
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: BYBEE, STEPHANIE
FACILITY NUMBER: 434411750
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2019
Section Cited

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Health and Safety Code: 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
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mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement was failed to be met as evidenced by LPA Almaraz observed Licensee Bybee did not have proof of completion of Mandated Reporter Training. This poses a potential risk to the health and safety of the children in care.
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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: 08/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4