434405634-8-16-2024-52-CC-JZHU-D87RBB-20240816125227

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434405634
Report Date: 08/16/2024
Date Signed: 08/16/2024 12:52:38 PM

Document Has Been Signed on 08/16/2024 12:52 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	GASPAY, MAYBELINE		FACILITY NUMBER:	434405634
ADMINISTRATOR/ DIRECTOR:	GASPAY, MAYBELINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 857-0126
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94303
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	08/16/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:50 AM
MET WITH:	Maybeline Gaspay		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

NARRATIVE

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On 08/16/2024 at 8:50am, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu and Licensing Program Manager (LPM) Chandra Charles met with licensee Maybeline Gaspay for an unannounced annual inspection. Present during the inspection were licensee, one (1) fingerprint-cleared assistant, and five (5) children in care (3 infants and 2 preschool-age children). The licensee is within ratio today. Upon arrival, LPA provided licensee a copy of the Entrance Checklist (LIC 126). The home was toured to conduct a Health and Safety Inspection. The facility’s current hours of operation are Monday-Friday from 8:00am-5:00pm.

The home is a one-story home with 4 bedrooms, 3 bathrooms, living room, family room, dining room, kitchen, Additional Dwelling Unit (ADU), front yard, and backyard. (The ADU was converted from a detached garage.) The on-limit areas are living room (converted to nap area equipped with play yards), family room (converted to main childcare area), 1/2 bathroom in family room, and backyard. The off-limit areas are all bedrooms, bathrooms in and by the primary bedroom, kitchen, dining room, outdoor areas on the sides of the house, and ADU, which will be inaccessible by closed and/or locked doors and visual supervision. The isolation area is the couch by the main entrance in the living room. When a child shows signs of illness, he/she will be separated from other children here.

The on-limit areas of the home is observed to be clean and orderly, with central heating and ventilation for safety and comfort. LPA observed there are ample safe and age-appropriate toys, play equipment and materials. There is a fully charged 3A40BC fire extinguisher in the family room. There is one (1) working smoke detector in the living room and one (1) combination smoke and carbon monoxide detectors in the kitchen. The home is equipped with telephone service and a fully stocked first aid kit. All toxins and hazardous materials have been made inaccessible to the children. Cleaning products (disinfectant sprays and wipes) were accessible to children in the on-limits bathroom, but licensee made them inaccessible during the inspection. There is a fireplace in the living room that is made inaccessible to children in care with a wire screen and an end table. Licensee does not transport children. Per licensee, there are no firearms and no pets in the home.

Page 1 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

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 5

Document Has Been Signed on 08/16/2024 12:52 PM - It Cannot Be Edited

Created By: Jialing Zhu On 08/16/2024 at 11:09 AM

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: GASPAY, MAYBELINE	FACILITY NUMBER: 434405634
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(d)

Operation of A Family Child Care Home

(d) The home shall provide safe toys, play equipment and materials. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as toys and play equipment (tricycles, bikes) are ample but not clean due to presence of spider webs and dirt. One (1) tricycle did not have pedals and the handle bars and pedal bars are exposed, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/30/2024
	Plan of Correction
1 2 3 4	Licensee will thoroughly clean the toys and play equipment in the outdoor play area and remove any broken equipment from the on-limit outdoor play areas. Licensee will submit photo(s) of cleaned toys and equipment and a written statement to confirm removal of broken equipment to LPA at jialing.zhu@dss.ca.gov.

Type B

Section Cited

CCR

102417(g)(4)

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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as multiple bottles of disinfectant spray (Lysol) and disinfectant wipes were left accessible to children in the on-limits bathroom on top and side of the toilet, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/30/2024
	Plan of Correction
1 2 3 4	Licensee made the disinfectant sprays and wipes inaccessible to children during the inspection, thus the deficiency has been corrected. Excess containers of soaps and hand sanitizers were also moved and made inaccessible to children.

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:

Chandra Charles

LICENSING EVALUATOR NAME:

Jialing Zhu

LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GASPAY, MAYBELINE	FACILITY NUMBER: 434405634
	VISIT DATE: 08/16/2024

NARRATIVE

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Play yards are also in the facility with the correct size mattresses and fitted sheets. Licensee provides bedding to the children during nap time. Children bring meals and snacks from home. All beddings and food brought from children’s home are be labeled with the children’s name and stored appropriately.

The outdoor play area is the backyard which is completely fenced with visual supervision. The outdoor play area is free from defects or dangerous conditions. There is an ample supply of age-appropriate toys and activities available for children. The condition of the toys and play equipment area not maintained as there are presence of spider webs and dirt. LPA observed one (1) tricycle to have no pedals and handle bars are exposed. There is ample shade available, and gates are locked at all times while children are in the backyard. There are pools are similar bodies of water on premises. There is a small working water fountain in the backyard but is filled with rocks and barricaded.

The licensee completed the Health and Safety training. The licensee’s Pediatric CPR/First Aid certification is current and expires on 04/08/2025. Licensee has completed the Mandated Reporter training for Child Care Providers and expires on 03/28/2025. The licensee is in compliance with the immunization laws. All adults living in the home have obtained a criminal record clearance.

The licensee conducts fire and disaster drills at least once every six months and the last conducted drill was on 06/14/2024. However, licensee was not able to provide documentation for the drills conducted. All required documents are posted and visible for public review.

LPA reviewed five (5) children’s files and one (1) staff file. There is a current roster available for review. The licensee owns the property and has liability insurance, which expires on 06/15/2025.

Licensee was reminded that California Law requires 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 624B). Any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Incidents must be reported within 24 hours by phone, fax, or email. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov.

Licensee was also reminded that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting https://mandatedreporterca.com/. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years.

Page 2 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GASPAY, MAYBELINE	FACILITY NUMBER: 434405634
	VISIT DATE: 08/16/2024

NARRATIVE

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Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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-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.

Licensee was informed of the MyChildCarePlan.org site, 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.

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) or (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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Page 3 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GASPAY, MAYBELINE	FACILITY NUMBER: 434405634
	VISIT DATE: 08/16/2024

NARRATIVE

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Two (2) Type B deficiencies and three (3) Advisory Notes were issued during today’s inspection. Please see attached advisory note pages for information on technical violations (TV) issued today.

Type B Deficiencies:

· Toys and play equipment in the outdoor play area are not maintained to be in good condition.

· Cleaning products (disinfectant sprays and wipes) were accessible to children in the on-limits bathroom, but licensee corrected this deficiency during the inspection.

Advisory Notes (TV):

· 2 of 5 children’s immunization records are not up to date or is missing.

· Mandated Reporter Training of assistant is not current and expired on 04/06/2024.

· Fire and emergency drills were conducted at least once every six months as required but not documented.

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Maybeline Gaspay. LPA provided licensee a copy of the Appeal Rights.

Page 4 of 4. End of Report.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC809 (FAS) - (06/04)

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