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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406076
Report Date: 10/14/2019
Date Signed: 10/14/2019 04:10:06 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:HIPPERT, MARTHA & MILDREDFACILITY NUMBER:
444406076
ADMINISTRATOR:HIPPERT, MARTHA & MILDREDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 335-2474
CITY:FELTONSTATE: CAZIP CODE:
95018
CAPACITY:14CENSUS: 11DATE:
10/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Martha Hippert TIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Zaid Hakim conducted an Unannounced Annual / Random Inspection at the facility today. Upon arrival, LPA observed two (2) school age children, two (2) infants under two years old, and seven (7) preschool age children engaging in daily activities with at least two (2) adults providing care and supervision, and met with Ms. Martha Hippert, Licensee. The Licensee and two other adults are the only individuals that reside in the home and all maintain valid fingerprint clearance. The days and hours of operation are Monday through Friday from 5:00am to 7:30pm. The Licensee states that she also operates on Saturdays occasionally. LPA observed required postings; including but not limited to the License to Operate, Emergency Disaster Plan (LIC 610) and Notification of Parents Rights (PUB 393). The facility is licensed for a maximum capacity of 14 children and the Licensee understands capacity options with the combination of age groups. At the time of the inspection LPA observed that the Licensee is in compliance with capacity and ratio requirements.

LPA toured the facility inside and out and observed all indoor and outdoor activity areas. LPA observed doors and locks securing storage areas and also signs and gates signaling off limit areas. Areas approved for day care use include: the play room (main activity room), the outdoor activity room, and one restroom. All other areas of the home and portions of the outdoor areas are off limits. The Licensee stated that there are no weapons or firearms in the home, no bodies of water on the premises, and no fireplaces in on-limit day care areas or areas accessible to children. The is a body of water in close distance to the premises, which is a creek that runs parallel to the home down the hill. The day care areas are secured through transparent fencing that is in good condition, secured by a self closing latch gate with the latch height inaccessible to children (approximately 5 feet high).

The facility is equipped with at least one smoke detector, one carbon monoxide detector, first aid supplies, and at least one 2A10BC fire extinguisher. The Licensee has been reminded that all fire safety items and fire extinguishers should be maintained at least once every 12 months.

LPA advised that licensing forms and all other information can be found at: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing

CONTINUATION ON FOLLOWING PAGE (PAGE #2 - REPORT DATED 10/14/2019):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019
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 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: HIPPERT, MARTHA & MILDRED
FACILITY NUMBER: 444406076
VISIT DATE: 10/14/2019
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 10/14/2019):

Toxic cleaning supplies and other items that pose a danger to children are securely stored high in inaccessible locations. The home has sufficient and safe toys, equipment, and supplies. The outdoor play area was observed to be safe and equipped with age appropriate toys and equipment. The outdoor play areas were observed to have secure perimeter fencing, age appropriate toys and supplies, and the children have access to shade and drinking water when needed. LPA reminded the Licensee that all equipment, items, fencing, and structures should be inspected and maintained regularly per children's health and safety.

The Licensee serves meals and snacks to children and is a participant in the Monterey Bay County Food Program. All foods served at the facility at any given time are communicated to parents and families beforehand through the Food Program website and the Licensee. The Licensee stated that she is aware of all food allergies or dietary restrictions of the children. The Licensee stated that there are no bouncers / walkers in the home and understands that bouncers / walkers may not be used in family home day cares. The Licensee stated that she understands that children that arrive to the facility in car seats must be removed from car seats upon entry. LPA observed all furnishings used by children to be safe and in good condition. The Licensee maintains pillows, cribs, pack and plays, and blankets for napping in the event of children wanting to rest. LPA and the Licensee discussed safe sleep practices for infants in detail.

The Licensee maintains an accurate roster of enrolled children. At least one staff maintains valid CPR / First Aid training, through an approved vendor, which expires in 09/2021. The Licensee understands that there must be at least one staff on site with Pediatric CPR / First Aid at all times, in the event of employing a helper, and has been reminded the Licensee that she shall have current CPR / First Aid certification at all times. Emergency disaster drills are done as required, last of which was completed in 09/2019. LPA and the Licensee discussed emergency disaster procedures in the event of a natural or man-made disaster. LPA and the Licensee discussed emergency information regarding the children in care, safety in times of crisis, home surveillance systems in common areas, and emergency supplies maintained in the home, and payment of Licensing fees. The Licensee stated the facility does not take off site field trips, driven or walking. The Licensee does provide transportation and understands in the event of transporting children, vehicle safety and that traffic and seat belt laws must be obeyed at all times. The Licensee does not assist enrolled children with medications at this time and is aware an Incidental Medical Services (IMS) Plan is required prior to any IMS being provided.

A review of staff records during today's inspection indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA 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.

CONTINUATION ON FOLLOWING PAGE (PAGE #3 - REPORT DATED 10/14/2019):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019
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: HIPPERT, MARTHA & MILDRED
FACILITY NUMBER: 444406076
VISIT DATE: 10/14/2019
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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 10/14/2019):

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

The Licensee has been referred to the department website for Licensing resource and updates: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing and has been advised to sign up for the CCL Quarterly Updates email list to stay current with changing legislation and new requirements.



LPA reminded the Licensee of the immunization requirement (pertussis, measles, and flu vaccines) for all staff that work directly with the childrenand the required "Mandated Reporter" training that all staff will be required to complete starting January 1, 2018.

https://mandatedreporterca.com/

LPA and the Licensee discussed recent changes to Mandated Reporter Requirements, Safe Sleep for Infants, Effects of Lead in Drinking Water, Positive Forms of Discipline, and precautions regarding children's outdoor activity time such as extreme heat or air quality.

A Notice of Site Visit has been issued and must remain posted for 30 consecutive days.

No Deficiencies have been cited as a result of today's inspection.
Exit interview conducted with Ms. Martha Hippert, Licensee
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3