434412084-9-23-2022-07-CC-SYIP-CJJT9F-20220923143152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412084
Report Date: 09/22/2022
Date Signed: 09/23/2022 02:32:12 PM

Document Has Been Signed on 09/23/2022 02:32 PM - It Cannot Be Edited

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:	09/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Jana Omaleki		TIME COMPLETED:	01:45 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 Jana Omaleki and explained the reason for the inspection. Upon arrival, Licensee was with seven (7) children, whom one (1) was infant age. Licensee's assistant was in the main home and came shortly after. LPA discussed with Licensee that if an assistant is not present that her license goes back to a small Family Child Care Home. There is area to post required postings, such as license and notification of parent's rights. There is working phone in the home. LPA toured the inside and outside of the home. Licensee uses the side home for the daycare children. The off-limit areas of the property are the main home and the home that is adjacent to the side home. The off-limit area inside of the side home is the kitchen. There are toys and equipment for children. Furniture were age-appropriate. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 12/22/2021. There are weapons, such as firearms, in the main home, which is locked. Ammunition is stored separately. Licensee does have pets in the home. The backyard is used and is fenced. Licensee also uses the driveway area in front of the home for children. Area is fenced. There are toys and equipment for children. LPA observed that equipment outside were dirty. LPA reminded Licensee to ensure that toys and equipment are wiped down and that anything that collect water is dumped out. --------------------continues on 809 dated 09/22/2022 page 2--------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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: 09/22/2022

NARRATIVE

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-------------------continuation of 809 dated 09/22/2022 page 1-------------------

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA discussed with Licensee that sleep log needs to conducted for children 2 years and under. There is play yard for the child. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee does not provide Incidental Medical Service (IMS). Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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

Licensee does not transport children, but understands that children cannot be left alone and unattended in parked vehicles.

A copy of the facility roster was obtained. Five (5) children's files were reviewed during today's inspection. The records reviewed include but not limited to parent's rights and immunization records. C-1 did not have notification of parent's rights on file. C-2's need the name of the child filled out on parent's right and on the consent for emergency medical treatment.

---------------------continues on 809 dated 09/22/2022 page 3--------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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: 09/22/2022

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-------------------continuation of 809 dated 09/22/2022 page 2-------------------

Licensee, her spouse, and her assistant (A-1)'s file was reviewed. Licensee has a valid CPR/1st Aid, which on 11/2022. Licensee completed the Mandated Reporter training on 06/17/2021 and her spouse completed it on 07/01/2022. Her assistant completed the General Training on 09/07/2021. LPA reminded Licensee that anyone helping with the children need to completed the Child Care Provider training, which needs to be renewed every two years. Assistant is missing immunization record for measles.

Adults 18 and over living in the home are Licensee, her spouse, her adult daughter, A-1, and A-2. All adults have cleared fingerprints or exemption. Licensee and her spouse's TB test results are on file. Assistant has her TB test on file. Licensee will submit TB test for her daughter. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee will submit the following:
- proof that Fire/Disaster Drill was conducted
- Sleep log for C-2
- Parent's right for C-1
- TB test for her daughter
- LIC 508 for A-2
- immunization records for measles and Mandated Reporter Training: Child Care Provider certificate for A-1
- Updated LIC 279

As as result of this inspection, Type B citations were issued. Exit interview conducted and report was reviewed with Licensee Jana Omaleki. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/23/2022 02:32 PM - It Cannot Be Edited

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: 09/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)1

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. The last fire drill was conducted on 12/2021.
	POC Due Date: 09/30/2022
	Plan of Correction
1 2 3 4	By POC 09/30/2022, Licensee will submit proof of fire/disaster drill to Licensing.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/23/2022 02:32 PM - It Cannot Be Edited

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: 09/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 1 persons, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2022
	Plan of Correction
1 2 3 4	By POC 09/30/2022, Licensee will conducted safe sleep check for infant in care and send proof to Licenisng.

Type B

Section Cited

CCR

102416.5(e)

Staffing Ratio and Capacity

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. Licensee's assistant was in the main home.
	POC Due Date: 09/30/2022
	Plan of Correction
1 2 3 4	By POC 09/30/2022, Licensee will submit a plan on how she will ensure that she will be within ratio at all times.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC809 (FAS) - (06/04)

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