434415442-8-8-2019-07-CC-SCOS-BEUQKK-20190808121425

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415442
Report Date: 08/08/2019
Date Signed: 08/08/2019 12:14:40 PM

COMPREHENSIVE INSPECTION

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:	LOMBARDI, ANTHONY & MARCELLA		FACILITY NUMBER:	434415442
ADMINISTRATOR:	ANTHONY & MARCELLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 991-4772
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95132
CAPACITY:	14	CENSUS: 4	DATE:	08/08/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:42 AM
MET WITH:	Marcella Lombardi		TIME COMPLETED:	12:13 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 August 8, 2019 Licensing Program Analysts LPA Stephanie Collins conducted an annual random inspection of the home. LPA met with Licensee Marcella Lombardi and explained the purpose of today's inspection. Present in the home were the Licensee and 4 preschoolers in care. Days and hours of operation are Monday through Friday from 07:00 AM – 6:00 PM. Licensee understands the capacity options. Adults residing in the home are both Licensee's Marcella Lombardi and Anthony Lombardi. A review of staff records on August 7, 2019 shows that all individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded 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. LPA inspected the indoor and outdoor areas of the home today. Smoke and Carbon monoxide detectors were tested and proved to be functioning. LPA observed a fully charged 2A10BC fire extinguisher. Last fire drill was conducted on July 1 2019. Off limits areas in home are as follows: All bedrooms, back-bathroom, and kitchen. Outside backyard is fully fenced. NO open bodies of water observed .

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

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 2

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: LOMBARDI, ANTHONY & MARCELLA	FACILITY NUMBER: 434415442
	VISIT DATE: 08/08/2019

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
26
27
28
29
30
31
32

Medication, cleaning products and similar items that can pose a danger to children if readily accessible are stored inaccessible to children. LPA reviewed the facility's roster and obtained a copy. Licensee states that there are no weapons in the home.

Licensee’s Pediatric CPR and First Aid are current and both licensees have completed training in Preventive Health Practices. LPA observed that both Licensees' have proof of immunity against Measles, Pertussis and proof of Tuberculosis clearances. Both Licensee completed AB1207 Mandated Reporter Training.

LPA reviewed children’s records review included Parents' Rights, immunization, Identification and Emergency Information, and Consent for Emergency Medical Treatment, Family Child Care Home Notification of Parents' Rights,
Licensee states that currently she is not providing Incidental Medical Services. 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. .

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

Safe sleep information was reviewed with Licensee.

LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

Exit Interview was conducted, where this report, was discussed and reviewed with Licensee. A copy of this report was given to Licensee.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2