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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004800
Report Date: 03/07/2024
Date Signed: 03/07/2024 02:39:40 PM

Document Has Been Signed on 03/07/2024 02:39 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:JAMESON, GLORIAFACILITY NUMBER:
414004800
ADMINISTRATOR:JAMESON, GLORIA C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 875-0336
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
03/07/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Gloria JamesonTIME COMPLETED:
02:40 PM
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On March 7th, 2024, at approximately 9:20 AM., Licensing Program Analysts (LPA) Gil conducted an unannounced, annual inspection. LPA met with licensee, Gloria Jameson, and explained the purpose of the inspection. Present during LPA’s visit included 6 infants, 1 preschooler, and 2 assistants. Licensee is a large license and is not operating within capacity limits and ratio. Two Type A citations were given to licensee for having an un-fingerprinted adult working in the home, as well as for being over capacity.
The licensee lives in a single-level home. All adults living and/or working in the home do not have fingerprint clearance on file. The hours of operation are Monday through Friday 7:30 AM. to 5:00 PM. Licensee does not provide any food or snacks. Per licensee, parents bring all food and formula for the children in her care.

Day Care Areas: Living Room, Bathroom, Bedroom# 1 and Play yard.
Off-Limit Areas: Kitchen, Garage, Bedroom # 2, Bedroom #3, bathroom #2, and other half of backyard area. All off limit areas are properly barricaded with child safety gates and/or child safety proof handles.

The Isolation Area for any sick children is the living room area near the front door. LPA inspected day care areas of home with licensee. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good working condition. LPA did not observe any accessible cleaning supplies, poisons, and solutions in day care areas. The living room includes a fireplace that is properly barricaded and made inaccessible. The licensee has a working cell phone available in the home. LPA observed electrical outlets to be made inaccessible with child safety covers. The home is equipped with a fully charged fire extinguisher and smoke and carbon monoxide detectors. LPA tested detector in living room near dining area, which was observed to be working. LPA observed a fully stocked first aid kit. LPA did not observe any hazardous materials in accessible drawers.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: JAMESON, GLORIA
FACILITY NUMBER: 414004800
VISIT DATE: 03/07/2024
NARRATIVE
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LPA reminded licensee that she should be documenting infant sleep logs every 15 minutes. Per licensee, she was unaware of this regulation and will start to document this. Licensee stated she will have this available by this next week and will send it to LPA Gil via email. A type B citation was given for not documenting infant sleep.



Bathroom for children's use was observed to be in proper working condition. LPA observed bathroom to include appropriate toileting equipment and sanitation products. LPA did not observe any hazardous materials to be accessible to children in bathroom.
LPAs observed licensee to utilize playpens for napping children. Playpens appeared empty, with only one having a tight fitted sheet. Per licensee, she does not have sheets in playpens because the children remove them while sleeping and throw them. LPA reminded licensee that she must have clean tight fitted sheets in each playpen. The back yard Day Care area is fully enclosed and fenced. The outdoor area is equipped with a variety of toys and materials. LPA did not observe pools, spas, or bodies of water.

LPA reviewed six children’s records which were incomplete. Children’s files do not have a record of emergency identification information and required immunization. LPA observed no liability insurance on file. Per licensee she plans to get childcare insurance in the future, but for now she will be having parents sign LIC 282. LIC 282 was provided. LPA also provided LIC 9227, which was also missing for all infant files. LPA reviewed staff records including licensee and assistant present, which were also incomplete. A type B was given for no immunization record present and incomplete files. Assistant #2 was asked to leave facility due to no fingerprint clearance. Per licensee, she does not have any forms or fingerprint clearance for her because she started working for licensee on 3/1/2022. Licensee's CPR/First Aid is current and will expire 06/2025. The licensee’s Mandated Reporter training certification is expired since 09/2021. All Staff and licensee present do not have required immunization available for review. All staff working with children do not current Mandated Reporter training certification. A Type B Citation was given.

Licensee has licensing documentation properly posted and available for review. Licensee also maintains a childcare roster that was made available for review. LPA reminded licensee that the roaster must be up to date and available for department during an inspection. Emergency disaster drills are not being conducted at least once every six months. LPA reminded licensee that this must be documented. Per licensee, there are no weapons or firearms in the home. Smoking is prohibited in the home.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: JAMESON, GLORIA
FACILITY NUMBER: 414004800
VISIT DATE: 03/07/2024
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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.

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/.

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

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: JAMESON, GLORIA
FACILITY NUMBER: 414004800
VISIT DATE: 03/07/2024
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During the exit interview, the licensee, Gloria Jameson, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA Janet Gil informed licensee Gloria Jameson that this report dated 3/07/2024 documents two Type A citations which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.


Also, LPA Janet Gil informed the director to provide a copy of this licensing report dated 3/07/2024 that documents two Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/07/2024 02:39 PM - It Cannot Be Edited


Created By: Janet Gil On 03/07/2024 at 01:10 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JAMESON, GLORIA
FACILITY NUMBER: 414004800

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in having an unfinger printed staff working without criminal clearance in her home day care facility which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/08/2024
Plan of Correction
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S3 was sent to get her finger prints done, and will not return to work until cleared. If she does not have sufficent children in her care licensee plans to not have S3 return.
Type A
Section Cited
CCR
102416.5(a)
Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in being over capacity in infants for her large license. Lisensee Gloria Jameson has 6 infants and 1 todler enrolled and present in her day care. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/08/2024
Plan of Correction
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Licensee plans to let go of some infants and change schedules around by notifing parents.
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:Garfield Leung
LICENSING EVALUATOR NAME:Janet Gil
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/07/2024 02:39 PM - It Cannot Be Edited


Created By: Janet Gil On 03/07/2024 at 01:10 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JAMESON, GLORIA
FACILITY NUMBER: 414004800

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in documenting infant sleep every 15 minutes which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/08/2024
Plan of Correction
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Licensee plans to document sleep in jornals for each infant and submit proof to the department by 3/15/2022.
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
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Based on record review, the licensee did not comply with the section cited above in having updated mandated reporter training for herself and her staff up to date and avalible for the department, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/08/2024
Plan of Correction
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Licensee plans to start mandated reporter training for her and her assitant tomorrow and send copies of certificate by next tuesday 3/12/2024.
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:Garfield Leung
LICENSING EVALUATOR NAME:Janet Gil
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/07/2024 02:39 PM - It Cannot Be Edited


Created By: Janet Gil On 03/07/2024 at 01:10 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JAMESON, GLORIA
FACILITY NUMBER: 414004800

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in having immunizations or any complete records avalible for herself and all staff which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/08/2024
Plan of Correction
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Lisensee plans to send missing immunization records by next week for all working staff in her home. If she needs to attend an appointment she will send appointment information to LPA Gil via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Garfield Leung
LICENSING EVALUATOR NAME:Janet Gil
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024


LIC809 (FAS) - (06/04)
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