434414609-6-14-2022-07-CC-MMOO-CFDSLQ-20220614135842

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414609
Report Date: 06/14/2022
Date Signed: 06/14/2022 01:58:52 PM

Document Has Been Signed on 06/14/2022 01:58 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:	METOVIC, KIMETA & ADZIJA		FACILITY NUMBER:	434414609
ADMINISTRATOR:	KIMETA & ADZIJA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 355-3687
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY:	14	CENSUS: 8	DATE:	06/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:36 AM
MET WITH:	Kimeta Metovic & Envera Krajnic		TIME COMPLETED:	02:15 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	On June 14, 2022 at 10:36 AM, Licensing Program Analyst (LPA), Marilou Monico, conducted a Required - 1 Year Inspection. LPA met with Licensee's helper, Envera Krajnic, and explained to her the purpose of today's visit . Envera was alone supervising seven daycare children including four (4) infants and three (3) preschool age. Envera stated that licensee went to drop off her grandson. Envera has CPR/First Aid certifications with an expiration date of March 31, 2024. Licensee, Kimeta Metovic, arrived at 11:02 AM. LPA was granted access to the home by the Licensee and toured both indoor and outdoor areas during the inspection. LPA observed all required posted materials. Days and hours of operation for the facility are Monday – Friday, 7:00 AM- 6:00 PM. There are no active waivers or exceptions for this facility. Licensee states there are two adults residing in the home: herself and her husband. 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. LPA observed that licensee does not maintain a current children's roster. Fire/disaster drill was conducted on January 3, 2022. LPA observed a fully charged 3A40BC fire extinguisher, functioning smoke and carbon monoxide detectors, glass covered fireplace, and barricaded wall heaters. Licensee states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. Licensee states that there are no weapons or firearms in the home. 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 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 Continuation on next pages:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022

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: METOVIC, KIMETA & ADZIJA	FACILITY NUMBER: 434414609
	VISIT DATE: 06/14/2022

NARRATIVE

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Indoor licensed areas of the facility were inspected by LPA today and observed to be clean, orderly, and safe for the day care children. Off limit areas in the home: one bedroom. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. Furniture, such as tables, chairs, couches, and shelves are in good condition and safe for children. The floors were clean and free of tripping hazards. Drinking water is readily available for children in the facility via sippy cups. The children's bathroom is clean, sanitary, and operable. The home has a working telephone which is (408) 355-3687.

LPA observed that one more daycare child (preschool age) and Licensee, Adzija Metovic, arrived during the inspection.

The outdoor licensed areas of the home were inspected and observed to be fenced in. Off limit areas outside the home: garage, gated portion of the backyard and right side yard. There were no bodies of water observed.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

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.

Eight (8) children’s files were reviewed during todays inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), and Immunization Records. Licensee carries daycare insurance.

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SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022

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: METOVIC, KIMETA & ADZIJA	FACILITY NUMBER: 434414609
	VISIT DATE: 06/14/2022

NARRATIVE

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LPA reviewed a helper's file (H1) for the following records: Criminal Record Statement, Statement Acknowledging Requirement to Report Child Abuse, Employee Rights, immunization in measles, pertussis and flu. Licensee's helper is missing proof of Mandated Reporter Training. Licensees, Kimeta and Adzija, have Immunization Record showing immunity to measles. pertussis, and flu. Both licensees do not have proof of Mandated Reporter Training. Kimeta and Adsija's CPR/First-Aid certifications expire on April 30, 2023. LPA reminded that Kimeta that Mandated Reporter Training must be renewed by all staff every 2 years. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Exit interview conducted and report was reviewed with the Licensee, Kimeta Metovic.

As a result of today's inspection, deficiencies were cited on the following pages:

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/14/2022 01:58 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: METOVIC, KIMETA & ADZIJA	FACILITY NUMBER: 434414609
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

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 LPA's observation, licensee's helper was alone in the home supervising seven children including four infants and three preschool age. This poses an immediate risk to the health, safety or personal rights of children in care. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
	POC Due Date: 06/15/2022
	Plan of Correction
1 2 3 4	Licensee states she will submit a written to ensure that she maintains the required ratio and capacity at all times. Licensee submitted a written plan during the inspection.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/14/2022 01:58 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: METOVIC, KIMETA & ADZIJA	FACILITY NUMBER: 434414609
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day 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 mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, both licensees and licensee's helper (H1) do not have proof that they completed the Mandated Reporter Training. This poses a potential risk to the health, safety or personal rights of children in care.
	POC Due Date: 07/28/2022
	Plan of Correction
1 2 3 4	Kimeta states that she will submit proof that herself, her husband, and her helper completed the Mandated Reporter Training by 07/28/22.

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, licensee does not maintain a current children's roster. This poses a potential risk to the health, safety or personal rights of children in care.
	POC Due Date: 06/17/2022
	Plan of Correction
1 2 3 4	Kimeta submitted a copy of current children's roster during the inspection. Deficiency corrected.

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: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022

LIC809 (FAS) - (06/04)

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