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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413551
Report Date: 02/26/2020
Date Signed: 02/26/2020 12:37:21 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:ROEBBERT, SHEILAFACILITY NUMBER:
434413551
ADMINISTRATOR:ROEBBERT, SHEILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 224-7397
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:14CENSUS: 8DATE:
02/26/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Roebbert, SheilaTIME COMPLETED:
12:41 PM
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Licensing Program Analyst (LPA) Almaraz, Araceli conducted an annual random inspection. LPA Almaraz met with Licensee, Roebbert, Sheila and explained the nature of today's inspection. Present during the inspection was the licensee and assistant Perez, Lori. There were eight children present. The hours of operation of the day-care are 9AM-12PM, Monday through Friday. There are three adults residing in the home; Licensee, spouse Roebbert, Franz, son Roebbert, Tyler and one minor child.

Physical Plant: LPA Almaraz inspected the indoor and outdoor areas of the home today. Off limit areas in the home are as follows; Entire upstairs, made inaccessible by gate, two bedrooms, one bathroom and garage. Off limit areas outside the home are as follows: None. The front yard is safety compliant and backyard is fully fenced. Licensee Roebbert states that there are no weapons in the home. LPA did not observe any bodies of water inside or outside the home. Medication, cleaning products and similar items are stored inaccessible to children. Poisons are locked. Licensee has two pets, vaccinated. LPA observed a working smoke/carbon monoxide detector, 3A40BC fire extinguisher last serviced 12/21/2019. LPA did not observe any heaters in the home. There is no fireplace, in home. LPA discussed the following with licensee: Safety door knobs to be placed on two bedrooms and one bathroom and the garage (off limits) to make them further inaccessible. Cover to be place on outdoor air-conditioning unit cover, for best practice.

Facility Records: Licensee Roebbert has CPR and First Aid, which has an expiration date of 08/30/2020. LPA observed that Licensee and assistant Perez have record of MMR & Tdap vaccinations, Perez has flu vaccine, licensee opted out. Licensee has day care insurance. 1/3
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
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)
Page: 1 of 3
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: ROEBBERT, SHEILA
FACILITY NUMBER: 434413551
VISIT DATE: 02/26/2020
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Licensee Roebbert completed Mandated Reporter Training on 06/13/2019, assistant Perez on 09/28/2019. Licensee and assistant understand training is to be completed every two years. LPA Almaraz reviewed eight 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 observed a current roster, a current fire disaster/earthquake drills last log 01/27/2020.

Supervision of the children was discussed; the Licensee understands the following: A cleared adult must be present in the home during day care hours. Children must be supervised at all times. 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.

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 02/25/2020 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



There are no deficiencies during today’s inspection. 1/3
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
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)
Page: 2 of 3
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: ROEBBERT, SHEILA
FACILITY NUMBER: 434413551
VISIT DATE: 02/26/2020
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LPA Almaraz conducted an exit interview with Licensee Roebbert and advised the licensee of the pending Department regulation update re: safe sleep for infant children. LPA 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 DAYS. 3/3
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
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)
Page: 3 of 3