434412084-6-12-2019-07-CC-SYIP-BD3QG9-20190612120911

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412084
Report Date: 06/12/2019
Date Signed: 06/12/2019 12:09:20 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:	OMALEKI, JANA		FACILITY NUMBER:	434412084
ADMINISTRATOR:	OMALEKI, JANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 779-4411
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	14	CENSUS: 7	DATE:	06/12/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Jana Omaleki and Paul Omaleki		TIME COMPLETED:	12:15 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	Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced annual random inspection. LPA met with Licensee Jana and Paul Omaleki and explained the reason for the inspection. Present during the inspection were Licensee, her spouse, who helps out with the day care, and 7 children, whom 4 were infant age. License, Notification of Parent's Rights, and Emergency Disaster Plan was observed to be posted. There is a working phone in the home. Licensee does carry daycare insurance. LPA toured the inside and outside of the home. Licensee uses the home of the left for day care children. The off limit area of the home is the kitchen. The main home is off-limit. There is no stairs or fireplace in the home. Furniture and equipment were age appropriate and in good condition. There is sufficient amount of toys for children in care. LPA observed bathroom for children's use. Disinfectants, cleaning solutions, sharp, and other items that are dangerous to children in care were stored inaccessible and out of reach of children. Children’s toys, play equipment and materials were safe and in good condition. There were no baby walkers or bouncers observed to be in use. Licensee understands baby walker and bouncers are not permitted in home. LPA observed a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. LPA reminded Licensee to ensure that smoke detector and carbon monoxide detector are functioning. The backyard is used for outdoor space and is fenced. Outdoor play equipment were age appropriate. There were no bodies of water observed during inspection. Licensee stated there are weapons, such as firearms, stored in the home, which is securely stored and out of reach of children. ---continues on 809 dated 06/12/2019 page 2----

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019

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: OMALEKI, JANA	FACILITY NUMBER: 434412084
	VISIT DATE: 06/12/2019

NARRATIVE

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----continuation of 809 dated 06/12/2019 page 2----

Licensee stated that she currently does not have any children in care who requires IMS services. Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Home Section 102417. 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.

LPA reviewed 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, a Type B deficiency has been cited. An exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were discussed with Licensee.

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: 06/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019

LIC809 (FAS) - (06/04)

Page: 2 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: OMALEKI, JANA	FACILITY NUMBER: 434412084
	VISIT DATE: 06/12/2019

NARRATIVE

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----continuation of 809 dated 06/12/2019 page 1----

Facility rosters was reviewed and a copy was obtained. 7 children’s files were reviewed during today inspection. The records reviewed include but not limited to immunization records and parent’s right notice.

Licensee’s CPR/ First Aid expires on 11/2020. Licensee stated that she and her spouse have not completed the Mandated Reporter Training, but will completed Mandated Reporter Training within 2 weeks. Licensee has immunization records for pertussis and measles. LPA obtain a copy of immunization record for Licensee. Licensee stated that she will send her spouse's immunization records to Licensing office.

LPA discussed Senate Bill 792 (immunization records for pertussis, measles, and flu vaccines), which began in 2016 for anyone working with the children and 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. Mandated Reported Training can be accessed at http://www.mandatedreporterca.com.

Adults who are over the age of 18 and reside in the home are Licensee, her spouse, and her daughter who is visiting. All adults living the home have cleared criminal records, child abuse index clearance or exemption, and TB clearance. 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.

Licensee stated that she does not transport children at this time, but understands that children should not be left alone and unattended in park vehicles.

---continues on 809 dated 06/12/2019 page 3----

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019

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: OMALEKI, JANA	FACILITY NUMBER: 434412084
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/12/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/28/2019 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...and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement was not met as evident by:	1 2 3 4 5 6 7	By POC 06/28/2019, Licensee stated she and her spouse will complete Mandated Reporter Training and send proof to Licensing office.
	8 9 10 11 12 13 14	Based on record reviews, Licensee has not completed Mandated Reporter Training, which poses a potential risk to the health and safety to the 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) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019

LIC809 (FAS) - (06/04)

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