434416742-9-3-2021-07-CC-MMOO-C6HPUD-20210903113721

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416742
Report Date: 09/03/2021
Date Signed: 09/03/2021 11:37:30 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:	WALL, JILL		FACILITY NUMBER:	434416742
ADMINISTRATOR:	JILL, WALL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 981-4148
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 1	DATE:	09/03/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Jill Wall		TIME COMPLETED:	11:50 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	On September 3, 2021 at 9:08 AM, Licensing Program Analysts (LPAs) Marilou Monico and Cortney Nelson conducted an announced prelicensing inspection in response to Applicant's request for a change of location application received by the Department. LPAs met with Applicant, Jill Wall, and explained the purpose of today's inspection. Also present in the home were Applicant's husband and her two-year-old son. LPAs note that Applicant was licensed at 8675 Muir Drive, Gilroy, CA 95020 (Facility number: 434414266). 9:15 AM - Application/Record Review: Applicant and her husband are the adults residing in the home. The Applicant resides in a one-storey, four bedrooms and 2 1/2-bathroom house. Days and hours of operation will be Monday to Thursday from 9:00 AM to 12:00 PM. The Applicant's CPR and First Aid certifications are current, with an expiration date of April 17, 2023. Applicant's Mandated Reporter Training for Child Care Workers expires on August 25, 2023. Applicant's husband owns the home and mortgage statement was submitted. All individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances prior to today's inspection. 09:30 AM - Physical Plant tour: There is a working telephone in the home (408) 981-4148. The home is clean and has heating and ventilation for safety and comfort. The daycare area inside the home is the dining area. LPAs observed that there's a barricaded fireplace in the living room. The off limit areas inside the home: kitchen, living room, four bedrooms, play room, two bathrooms, and garage. Off limit areas outside the home: hill areas. There are safe and age appropriate toys, play equipment, and materials for the children in the home. The Applicant has a designated area in the home where a child(ren) can be isolated if exhibiting signs of illness. The home has working smoke/carbon monoxide detector. There is a climbing structure in the outdoor play area that is bolted to the ground. Continuation on next pages:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021

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: WALL, JILL	FACILITY NUMBER: 434416742
	VISIT DATE: 09/03/2021

NARRATIVE

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Physical Plant tour (cont.): The Applicant has three fire extinguishers (2A10BC) in the home that is fully charged. The Applicant states that he does not have any firearms in the home. All cleaning compounds, sharp objects, medications, and other similar items are stored inaccessible to the children. The Applicant understands that baby walkers, baby bouncers, jumpers, and saucer chairs are not allowed in the home. The Applicant states that no one in the home smokes and he understands that smoking is prohibited in the home. The Applicant has a first aid kit in the home. There were no bodies of water observed.

10:30 AM - Kitchen tour: The refrigerator and freezer in the home. The kitchen area is gated. The Applicant understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated.

10:40 AM - Bathroom tour: The children's bathroom is clean, safe, and operable. Sharp objects and cleaning products are stored inaccessible to children.

10:50 AM - Document/Regulation Review: A Family Child Care Home packet with updated Licensing forms was provided to Applicant. Documents from the packet, including but not limited to the following were discussed and reviewed with the Applicant: 1) Child Care Facility Roster (LIC 9140) must be complete and current at all times, 2) Fire/disaster drills must be practiced at least once every 6 months and documented on the fire/disaster drill log provided to the Applicant, 3) Posting requirements - Parent's Rights (PUB 394), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), and Facility License, 4) Staffing & Ratio - capacity/ratio limitations handout, 5) Safe Sleep Regulations (PIN 20-24-CCP), 6) Lead Flyer Requirement (PIN 20-01-CCP), and 7) Forms and Records to keep in your Family Child Care Home (LIC 311D).

Applicant states that he will use positive discipline (reinforcing positive behavior) as form of discipline. The Applicant understands that children's personal rights should not be violated; including no corporal punishment, supervision of children, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed with the Applicant.

Continuation on next page:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021

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: WALL, JILL	FACILITY NUMBER: 434416742
	VISIT DATE: 09/03/2021

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed with the Applicant. 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. The Applicant states that she does not plan on administering medication to the day care children at this time.

11:00 AM - Notification requirements/civil penalty: LPAs discussed the requirements of AB 633 with the Applicant. The Applicant understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPAs discussed "zero tolerance" related regulations with the Applicant and advised her of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected. LPAs reminded the Applicant 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.

During today's inspection, Applicant submitted mortgage statement and a letter to close facility #4344114266.

Fire clearance was granted on August 27, 2021.

LPAs conducted an exit interview and advised the Applicant that a Large Family Child Care Home license will be approved upon completion of the following:

1) Updated Facility Sketch (LIC 999A)
2) Photos of barricaded stairs: hallway leading to the bedrooms, dining area to the front door, outside the play area
3) Photos showing that the dining area is fully set up for daycare
4) Manager's review and approval

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021

LIC809 (FAS) - (06/04)

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