434415230-9-12-2019-07-CC-MSMS-BFXPJW-20190912112212

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415230
Report Date: 09/12/2019
Date Signed: 09/12/2019 11:22:25 AM

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:	SMITH, JULIE MARIE		FACILITY NUMBER:	434415230
ADMINISTRATOR:	SMITH, JULIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 207-5640
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94085
CAPACITY:	14	CENSUS: 7	DATE:	09/12/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Julie Marie Smith		TIME COMPLETED:	11:20 AM

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 Analysts (LPAs) Mel Matos, Susy Cervantes, and Pete Hernandez, met with Julie Marie Smith, Licensee, for an unannounced annual/random inspection. LPAs also observed one adult assistant (Esmeralda Caballero) and seven day care children (3 infants & 4 preschool) in the home during today's inspection. Days and hours of operation are Monday - Friday from 8:00 AM to 5:30 PM. The Licensee is the only adult residing in the home. Licensee's certifications for CPR and First Aid are current and expire on February 10, 2021. LPAs reviewed the Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on April 3, 2019. LPAs reviewed seven children's files during today's inspection. LPAs observed that the immunization records of Children #2 & #3 were not present in the files reviewed. LPAs observed current and updated immunization records for the remainder of the five children's files reviewed. The Family Child Care Home Notification of Parents' Rights forms (LIC 995A) were observed in all seven children's files reviewed. LPAs observed that the Licensee and her adult assistant has record of MMR & Tdap vaccinations as well as the opt out form for the flu vaccine. The Licensee and her adult assistant has record of completion of the Mandated Reporter training for child care workers (completed 08/30/2019). LPAs toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters inside the home. There are no stairs inside the home. Off limit areas inside the home: three bedrooms, kitchen, barricaded fireplace unit, and attached garage. Off limit areas outdoors: right and left side entry areas of the backyard. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 09/12/2019):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2019

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: SMITH, JULIE MARIE	FACILITY NUMBER: 434415230
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/12/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/27/2019 Section Cited	1 2 3 4 5 6 7	Immunizations: The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: The immunization records of Children #2 & #3 were not present in the files reviewed during today's inspection. This presents a potential risk to the health/safety of children in care.	8 9 10 11 12 13 14
	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: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2019

LIC809 (FAS) - (06/04)

Page: 3 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: SMITH, JULIE MARIE	FACILITY NUMBER: 434415230
	VISIT DATE: 09/12/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 09/12/2019):

LPAs observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.

A review of staff records on September 11, 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. LPAs also reminded the Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, 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.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time with a qualified assistant present. The Licensee states that she does not transport any children. The Licensee states that she does not administer any medication to the children.

LPAs provided the Licensee with a copy of the lead poisoning facts flyer and advised her of the upcoming safe sleep regulations.

The following deficiency is issued on the attached page (809-D) as a result of today's inspection. LPAs conducted an exit interview with the Licensee prior to the conclusion of today's inspection and provided her with copies of appeal rights.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2019

LIC809 (FAS) - (06/04)

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