376614286-5-12-2023-51-CC-NDIZ-CRRQTJ-20230512122712

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376614286
Report Date: 05/12/2023
Date Signed: 05/12/2023 12:27:26 PM

Document Has Been Signed on 05/12/2023 12:27 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	BERTHIAUME, JENNIPHAR FAMILY CHILD CARE		FACILITY NUMBER:	376614286
ADMINISTRATOR:	JENNIPHAR BERTHIAUME		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 847-3401
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92120
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 15	CENSUS: 9	DATE:	05/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:			TIME COMPLETED:	12:45 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 5/12/23 @ 10:45AM, LPA Nancy Diaz conducted an unannounced inspection. LPA disclosed the purpose of the inspection and was granted facility entry by the Licensee. A tour of the home was conducted with Mrs. Berthiaume. Observed present today were 9 children (3 children were under age 2). Helpers Kasey Dill and Destiny Gutierrez were also present today. The following areas are accessible to children daycare room, hallway bathroom, nap room and back fenced yard. Facility operates M-F; 8:00AM to 4:30PM. Observed in the yard is a spa with a locked cover. The trampoline in the yard is currently not being used because of some repairs that needed to be done. The licensee was present in the home to ensure that all children are supervised at all times. Facility is within capacity and did not exceed the capacity specified on the license. There is a spa located in the yard that is covered as specified by regulation. Licensee stated that she does not maintain any weapons in the home. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored appropriately and inaccessible to children. Fire extinguisher and smoke detectors meet State Fire Marshall standards. The carbon monoxide detector present in the home meet the standards established in Chapter 8 of Part 2, Division 12. Home is kept clean and orderly with heating and ventilation for safety and comfort. Licensee provide safe toys, play equipment and materials. The home maintains a working telephone service. There is a play pen for each infant who is unable to climb out of the play pen. The play pen was observed to be free from all loose articles and objects. Bumper pads are not used. There are no objects hanging above or attached to the side of the crib. Infants are not swaddled while in care. Infants are supervised while they sleep. The provider check on sleeping infants every 15 minutes.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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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Document Has Been Signed on 05/12/2023 12:27 PM - It Cannot Be Edited

Created By: Nancy Diaz On 05/12/2023 at 12:04 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: BERTHIAUME, JENNIPHAR FAMILY CHILD CARE	FACILITY NUMBER: 376614286
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 & record review, the licensee did not comply with the section cited above. Mrs. Berthiaume stated that she checks on napping infants every 15 minutes, however she does not maintain logs. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	LPA provided Mrs. Berthiaume a sample copy of a 15-minute nap log today. She stated that she will start using the forms effective immediately. Licensee shall submit sample copies of infant nap logs (for 3 infants) to the department no later than 5/19/23 via email to - nancy.diaz@dss.ca.gov

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:

Tashima Daniel

LICENSING EVALUATOR NAME:

Nancy Diaz

LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: BERTHIAUME, JENNIPHAR FAMILY CHILD CARE	FACILITY NUMBER: 376614286
	VISIT DATE: 05/12/2023

NARRATIVE

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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.

Car seats are only used for transportation purposes and not used for sleeping. Infants are supervised while they sleep.

The outdoor play area is fenced or supervised by the licensee. An isolation area has been designated for children who became ill during the day.

Children’s records were reviewed. Licensee maintains a copy of the emergency information card that contains all of the information specified by the regulation.

Staff records were reviewed. Staff have completed the mandated reporter training pursuant to Health & Safety Code. Licensee was made aware that the mandated reporter training shall be renewed every 2 years.
Staff have been immunized against influenza, pertussis and measles. Licensee’s CPR and First aid is valid thru July 2024.

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.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: BERTHIAUME, JENNIPHAR FAMILY CHILD CARE	FACILITY NUMBER: 376614286
	VISIT DATE: 05/12/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. Licensee does not maintain medications for daycare children. 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

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. 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.

TYPE B DEFICIENCY WAS CITED TODAY.

Exit interview conducted and report was reviewed with facility representative, Jenniphar Berthiaume. A copy of this report, along with Appeal Rights (LIC9058), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC809 (FAS) - (06/04)

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