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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629872
Report Date: 02/26/2024
Date Signed: 02/26/2024 01:26:03 PM

Document Has Been Signed on 02/26/2024 01:26 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:TERGENE, JOHANNE FAMILY CHILD CAREFACILITY NUMBER:
376629872
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 0DATE:
02/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Johanne TergeneTIME COMPLETED:
01:45 PM
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On 02/26/24 at 12:00PM, LPA, Luigi Gargaro, conducted an announced prelicensing inspection for a relocation with the applicant to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. The one story home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher and smoke and carbon monoxide detectors meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. The applicant was asked whether she had any bodies of water or weapons in the home and she replied no. CPR and First Aid expire in November of 2024 for the applicant. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Applicant rents the home and provided proof of control of property in the form of a lease agreement that was included with the original application.

Applicant will be using the following rooms for childcare: the primary day care room and the day care bathroom. Off limits areas are the kitchen, the home living room, the three home bedrooms with one additional inclusive bath and the garage. The kitchen and living room are made off limits with retractable screen gating that is installed at the front entrance to the kitchen and at the entrance area leading into the living room from the hallway. The bedrooms are made off limits with door knob covers that are installed on their respective door handles. The home entrance to the garage is found in the off limits bedroom #1 making it inaccessible to day care children.

The applicant has sufficient toys and equipment available. The home has a gated backyard area immediately off the house that is available for outdoor activities. The yard behind the secured, gated area is off limits to the day care as it is not fully landscaped and the applicant does not want to use it for her facility. The gated front yard is also off limits as it too will not be used for the day care.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2024
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: TERGENE, JOHANNE FAMILY CHILD CARE
FACILITY NUMBER: 376629872
VISIT DATE: 02/26/2024
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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. LPA and applicant discussed California Megan's Law and he provided applicant with the website address: www.meganslaw.ca.gov for her to review information regarding her facility on a regular basis. Unusual Incident Reports may be e-mailed to: SDIncidentReports@dss.ca.gov.

Applicant was reminded of requirements for children’s records, child abuse and unusual incident reporting, immunizations, adults living or working in the home and associated civil penalties, shaken baby syndrome, and SIDS. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care.

No corrections are required and a license for 8 will be issued today at this new location.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
LIC809 (FAS) - (06/04)
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