434413551-7-13-2023-07-CC-JCRZ-CTPP7G-20230713110352

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413551
Report Date: 07/13/2023
Date Signed: 07/13/2023 11:03:57 AM

Document Has Been Signed on 07/13/2023 11:03 AM - 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ROEBBERT, SHEILA		FACILITY NUMBER:	434413551
ADMINISTRATOR:	ROEBBERT, SHEILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 460-7880
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	07/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:37 AM
MET WITH:	Sheila Roebbert		TIME COMPLETED:	11:30 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	Licensing Program Analyst (LPA) Janette Cruz met with Sheila Roebbert, Licensee, for an unannounced Required 1-year annual inspection. LPA was granted access to the home by the Licensee. LPA also observed, Licensee's son, Tyler Roebbert, Licensee's minor daughter, and two children (one preschool, one school-age) present in the home during today's inspection. The Licensee was operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, posted inside the home. Days and hours of operations are M, T, W, TH from 9:00 AM to 12PM. The Licensee, her spouse, Franz Roebbert, Licensee's adult son and minor daughter are currently residing in the home. Licensee has clearance for Tuberculosis and Criminal Background/Child Abuse Index clearances. There are no active waivers for this facility. Licensee has current CPR and First Aid certifications (expiration: 01/2025). LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on 01/17/2023. Licensee has an active Child Care Liability Insurance (valid 08/31/2023). Licensee has the required vaccinations (MMR, Tdap, & flu) and is current with the Mandated Reporter Training for Child Care Workers (expiration: 03/08/2025). LPA reviewed a child's file. LPA discussed the safe sleep regulations with the 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 the 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.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ROEBBERT, SHEILA	FACILITY NUMBER: 434413551
	VISIT DATE: 07/13/2023

NARRATIVE

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LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone (408) 460-7880 in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Licensee states that a child will be isolated in living room area of the home if necessary due to illness or communicable disease.

LPA observed a two-story home that is clean, orderly, and safe for the day care children. LPA also observed no fireplace and no open face heater units inside the home. The Licensee has dining room and family room primarily used for day-care. Off limit areas inside the home are as follows; the entire upstairs (one bedroom/bathroom) which is gated, and downstairs : two bedrooms, one bathroom and garage. Off limit areas outside the home are as follows: None.

LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. The Licensee states that she does not have weapons in the home. Licensee has two small dogs (chihuahua) kept away from children. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. All poisons are stored in high cabinets inaccessible to children. The Licensee states that she administers medication to the day care children as needed.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 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: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ROEBBERT, SHEILA	FACILITY NUMBER: 434413551
	VISIT DATE: 07/13/2023

NARRATIVE

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Supervision of children was discussed with Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time without a fully qualified adult present. Licensee states does not transport day care children. The Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

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.

LPA provided Licensee with website resources on managing food allergies at school and handling medical emergencies related to food allergies.

CDC Managing Food Allergies at School
https://www.cdc.gov/healthyschools/foodallergies/index.htm

American Academy of Pediatrics Healthy Children Medical Emergencies
https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/When-to-Call-Emergency-Medical-Services-EMS.aspx

Exit interview conducted and report was reviewed with the Licensee, Sheila Roebbert. A deficiency was issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/13/2023 11:03 AM - It Cannot Be Edited

Created By: Janette Cruz On 07/13/2023 at 10:46 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ROEBBERT, SHEILA	FACILITY NUMBER: 434413551
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421(a)

Child's Records

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above, Licensee did not maintain child's file for C2 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/27/2023
	Plan of Correction
1 2 3 4	Licensee will submit a complete child's file for C2 by POC due date. Licensee will submit a written statement stating understanding of Title 22 102421 Child's Records.

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:

Diana Stephenson

LICENSING EVALUATOR NAME:

Janette Cruz

LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC809 (FAS) - (06/04)

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