<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423567
Report Date: 03/30/2022
Date Signed: 03/30/2022 03:45:49 PM

Document Has Been Signed on 03/30/2022 03:45 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:PRIMAS, TONJAFACILITY NUMBER:
013423567
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
03/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Tonja Primas TIME COMPLETED:
04:15 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
On 3/30/2022 at 9:48am, Licensing Program Analysts (LPAs) Catherine Fernandes and Indira Loza met with Licensee Tonja Primas for an Unannounced Annual Required Inspection. Present during the inspection was the Licensee and one infant and five preschoolers in care. Residing in the home is the Licensee and her now adult son. During the inspection the Licensee's mother come to help with the children. The Licensee’s home was toured for a health and safety inspection. The facility operates from 7:30am – 5:30pm Monday through Friday.

The facility is a single story home with 2 bedrooms and 1 bathroom. The inside of the home was observed to be neat and clean with ample age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be locked. Licensee has stated that there no firearms and no pets in the home.


ON LIMITS AREA: Living Room, kitchen, dining room, the bathroom, the laundry room leading to the back yard, the fenced in backyard and the front yard of the home. LPAs reminded the licensee that when the children are in the front yard 100 percent supervision is required at all times.
OFF LIMITS AREA: The bedrooms.
ISOLATION AREA: will be the couch next to the front door.
The home has a fully charged 2A10BC fire extinguisher in the kitchen. There is a working smoke detector in the living room and a carbon monoxide detector in the kitchen. The home is equipped with central heating and was covered by a gate during todays inspection. The backyard has a swing set that is bolted to the cement and a small trampoline, LPA Fernandes advised the licensee to be sure to follow directions on how to use the play equipment.
The Licensee’s Health and Safety training has been completed. Licensee is scheduled to take a CPR class April 16, 2022 and has a complete first aid kit. All required forms are posted and visible for public view by the front door. LPA reviewed six children’s files. LPA obtained a current facility roster. LPA observed a current fire and disaster drill log with the last drill conducted on September 2021, Licensee stated one will be conducted today.
Report continues on 809C.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2022
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 10
Document Has Been Signed on 03/30/2022 03:45 PM - It Cannot Be Edited


Created By: Indira Loza On 03/30/2022 at 01:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: PRIMAS, TONJA
FACILITY NUMBER: 013423567

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(10)
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: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observations there was a baby bouncer in the day care home, the licensee did not comply with the section cited above, which poses a potential personal rights risk to persons in care.
POC Due Date: 04/29/2022
Plan of Correction
1
2
3
4
Licensee is to remove the item from the home and review Personal Rights regulations and Health and Safety Code 1596.846(b) and (c). Then write a statement of completion to CCL by proof of correction date.
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview the licensee checks on the infant but does not document the checks, the licensee did not comply with the section cited above, which poses a safety risk to persons in care.
POC Due Date: 04/29/2022
Plan of Correction
1
2
3
4
Licensee is to review safe sleep regulations and write a statement of completion. Then send a written statement to CCL by proof of correction date.
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:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022


LIC809 (FAS) - (06/04)
Page: 10 of 10
Document Has Been Signed on 03/30/2022 03:45 PM - It Cannot Be Edited


Created By: Indira Loza On 03/30/2022 at 01:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: PRIMAS, TONJA
FACILITY NUMBER: 013423567

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review there are no current mandated reporter training, the licensee did not comply with the section cited above in two out of two staff members, which poses potential health safety risk to persons in care.
POC Due Date: 04/29/2022
Plan of Correction
1
2
3
4
Licensee is to complete mandated reporter training for all persons that care for children, then send copies to CCL by proof of correction date.
Type B
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview the licensee's son turned 18 and does not have finger print clearance, the licensee did not comply with the section cited above, which poses safety risk to persons in care.
POC Due Date: 04/29/2022
Plan of Correction
1
2
3
4
Licensee is to have her son get fingerprinted and until the clearance goes through he can not be around the children in care. Then send proof of fingerprints to CCL by proof of correction date.

*during the inspection the licensee scheduled an appointment for fingerprints for 3/31/22.
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:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022


LIC809 (FAS) - (06/04)
Page: 8 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PRIMAS, TONJA
FACILITY NUMBER: 013423567
VISIT DATE: 03/30/2022
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
The following deficiencies were observed and cited during todays inspections.
-Licensee's adult son is now 18 years of age and is not fingerprint cleared and associated to the home
-LPAs observed a baby bouncer in the home
- Six out of six children's files were incomplete
- There is an infant under 12 months of age and does not have a Sleep plan.
- No files were observed for Licensee's mother and adult son

There is a child enrolled who needs an IMS.

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 Licensee is providing IMS as of today and will submit the form to CCLD.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/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 web page athttps://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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience.
Report continues on 809C.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC809 (FAS) - (06/04)
Page: 7 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PRIMAS, TONJA
FACILITY NUMBER: 013423567
VISIT DATE: 03/30/2022
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
 If you have any questions regarding the process or tools, please send them by email 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/process.

See 809D deficiencies cited during todays inspection.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted with Tonja Primas
Report and Appeal Rights provided
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 03/30/2022 03:45 PM - It Cannot Be Edited


Created By: Indira Loza On 03/30/2022 at 03:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: PRIMAS, TONJA
FACILITY NUMBER: 013423567

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review there is no infant sleep plan for the infant, the licensee did not comply with the section cited above, which poses a potential safety risk to persons in care.
POC Due Date: 04/29/2022
Plan of Correction
1
2
3
4
Licensee is to met with parents and complete the infant sleep plan and send a copy to CCL by proof of correction date.
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:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022


LIC809 (FAS) - (06/04)
Page: 6 of 10