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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010216105
Report Date: 10/01/2024
Date Signed: 10/01/2024 12:15:50 PM

Document Has Been Signed on 10/01/2024 12:15 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:JUBILADO, TERESAFACILITY NUMBER:
010216105
ADMINISTRATOR/
DIRECTOR:		JUBILADO, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 790-2724
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
10/01/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Theresa JubiladoTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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On October 1, 2024, Licensing Program Analyst (LPA) Lorraine Dacanay Breaux and met with licensee Teresa Jubilado for an Unannounced Required 1 Year Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. LPA provided LIC 126. Present during inspection was licensee, licensee finger print cleared husband and daughter/assistant Jessica Jubilado and five (5) children (1 infant and 4 toddlers). Hours of operation: Monday - Friday 7:00am - 5:30pm.

The home is two story and has 3 bedrooms with a loft and 2.5 bathroom. The home was neat and orderly, with heating and ventilation for safety and comfort. ISOLATION AREA: A section in the Living room away from other children in care.

On limit areas include: Living room, dining room and bonus room (childcare room), downstairs bathroom, laundry room (travel to bathroom) and backyard.

Off-limits areas include: Entire second (includes all bedrooms, loft area and 2 bathrooms), kitchen, and two car garage which are made inaccessible by closed and/or locked doors and visual supervision. There is a gate at the bottom of the stairs to prevent access to the upper level. There are no pools, hot tubs or any other bodies of water present. Licensee confirmed there are no pools/bodies of water during today's inspection. LPA did not observe any hazardous materials or toxins accessible to children during today's inspection. There are age appropriate toys that are safe and in good condition.

The home has a fully charged 3A40BC fire extinguisher located in the kitchen, working smoke/carbon monoxide detectors located in the hallway (tested and functioning), fully stocked first aid kit and working telephone. The fireplace is located in the living room, it is blocked and inaccessible to children in care. Per licensee there are no firearms in the home. Per licensee resides in the home. Per licensee she does not provide transportation.



LIC 809-C
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: JUBILADO, TERESA
FACILITY NUMBER: 010216105
VISIT DATE: 10/01/2024
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At 11:20 AM, LPA requested and reviewed the files of two (2) children files and personnel files. The children's files contained, Parents rights, medical consent forms and identification and emergency contacts. The facility roster was review and copies were obtained. The licensee conducts fire and disaster drills once month and the last was conducted on 09/03/2024. The licensee has current CPR/First aid certificate which expires on 12/30/2025. Mandated Reporter training is current and was completed on 06/06/2024. Assistant/daughter Jessica has current CPR which expires on 11/11/2025 and Mandated Reporter training is current and was completed on 11/11/2025. The licensee is in ratio today. All required forms are posted and visible for public review.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP . 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: https://www.ada.gov/resources/child-care-centers/.

Per licensee does not administer medication at this time.

LIC 809-C
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: JUBILADO, TERESA
FACILITY NUMBER: 010216105
VISIT DATE: 10/01/2024
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California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone to the regional office and written report within 7 days. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

During the exit interview, the Licensee Teresa Jubilado, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies cited during today's visit. A notice of site visit was given and must remain posted for 30 days. Appeal Rights provided. Exit interview conducted and report was reviewed with the licensee Teresa Jubilado.



End of Report
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC809 (FAS) - (06/04)
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