444406076-10-21-2021-07-CC-KGOL-C7YS5Q-20211020133442

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444406076
Report Date: 10/20/2021
Date Signed: 10/21/2021 11:40:21 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:	HIPPERT, MARTHA & MILDRED		FACILITY NUMBER:	444406076
ADMINISTRATOR:	HIPPERT, MARTHA & MILDRED		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 335-2474
CITY:	FELTON	STATE: CA	ZIP CODE:	95018
CAPACITY:	14	CENSUS: 6	DATE:	10/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Hippert, Martha		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	Licensing Program Analyst (LPA) Goodell met with licensee, Martha (Kay) Hippert, for the purpose of an Unannounced Annual Random Inspection. Hours of operation are Monday- Friday, 5:30 am- 6:30pm. During inspection, LPA observed six children present with licensee. All individuals subject to criminal background review have obtained a criminal record clearance. LPA observed Facility License, Notification of Parent’s Rights (PUB394), Emergency Disaster Plan (LIC610A) and Earthquake Preparedness Checklist (LIC9148) posted. Inspection was conducted in all areas accessible to children which include daycare room (located in detached converted garage), bathroom, fenced outdoor deck (attached to daycare room) and fenced outdoor next to daycare room). LPA observed the outdoor daycare area and deck fenced transparent and at least 5ft in height. Off-limits areas include main house, front unfenced front yard, fenced backyard deck (located behind house) and three outdoor storage units. LPA verified current phone number and email are current. LPA also observed a 2A10BC fire extinguisher, smoke and carbon monoxide detectors located in playroom. No weapons or poisons observed in the home. The body of water is a creek that runs parallel to the home down the hill located off-limits. A non-operating empty pool is located in the off limits deck behind main house with a transparent fence that is at least 5ft with a self latching gate. LPA also observed an empty jacuzzi with cover not fully latched in the off-limits area which poses a potential risk to children in care. Licensee acknowledged requirement and stated Jacuzzi is non-operational. Licensee also scheduled to be dismantled and removed from the property. Licensee stated proof will be submitted to LPA by POC due date. Licensee acknowledged that 100% supervision is required in unfenced area. LPA observed cleaning compounds, medication and knives are stored inaccessible to children. Children's records were reviewed. LPA observed child Infant Sleeping Plan (LIC9227) and log. LPA observed fire drill log and children roster maintained. Personnel Records also reviewed. Preventative health training verified. Current pediatric CPR and first aid certification expires 8/2023. Report continues on LIC809-C.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

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: HIPPERT, MARTHA & MILDRED	FACILITY NUMBER: 444406076
	VISIT DATE: 10/20/2021

NARRATIVE

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The Effects of Lead Exposure brochure was issued and discussed. All Inclined sleepers are prohibited per: PIN 19-16-CCP was issued and discussed. LPA observed X infants present. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage 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. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, forms, self-assessment guides, legislation and regulation information. To receive Quarterly Updates via email request by email to childcareadvocatesprogram@dss.ca.gov.

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 Mandated Reporter Training was discussed. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. In addition, effective January 1, 2018: Applicants must meet requirements as a precondition to licensure, existing licensees must meet requirements by March 30, 2018, new employees shall have 90 days from date of employment to complete training as required. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com

Title 22 deficiencies cited on the attached LIC 809D. This facility evaluation report was reviewed and discussed with the licensee. A notice of site visit issued and remain posted for 30 days. Licensee acknowledged that a copy of this report will remain on file for a period of three years for public review upon request. Appeal Rights were also issued and discussed.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

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: HIPPERT, MARTHA & MILDRED	FACILITY NUMBER: 444406076
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/20/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(5)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above due to LPA observed an empty jacuzzi located in off limits. Although day care area is separate and fully fenced with a transparent fence that is at least 5ft in height, LPA observed jacuzzi cover not fully latched in the off-limits area which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/25/2021
	Plan of Correction
1 2 3 4	Licensee stated jacuzzi is non-operational and is scheduled to be dismantled and removed from the property. Licensee acknowledged and stated proof will be submitted to LPA by POC due date 10/25/21.

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: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

LIC809 (FAS) - (06/04)

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