434416177-7-8-2021-07-CC-JMAS-C4QNNX-20210708103727

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416177
Report Date: 07/08/2021
Date Signed: 07/08/2021 10:37:40 AM

Document Has Been Signed on 07/08/2021 10:37 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:	HARRIS, LAKISHA		FACILITY NUMBER:	434416177
ADMINISTRATOR:	LAKISHA HARRIS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 460-6045
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	07/08/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Daniela Castaneda		TIME COMPLETED:	10:50 AM

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Licensing Program Analyst (LPA) Joe Macias conducted an unannounced Annual Required (tool kit #1) Inspection. LPA was greeted and granted entrance by the Licensee's assistant Daniela Castaneda, as the Licensee is on vacation. The purpose of today’s inspection is to ensure the home is in compliance with Title 22 California Code of Regulations. Todays census is 6 (1 infant, 4 preschool age, 1 school age). The Licensee is the only adult who reside in the home. The day care hours of operation are Monday - Friday, 7am - 6pm. The Licensee's Assistant's CPR and First Aid are current, and expire July 2022.

LPA toured the indoor and outdoor areas of the home during today's visit. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's visit. The last fire disaster drill was conducted on July 7, 2021. LPA Macias reviewed the children files and observed all required documents present. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the children in care. LPA did not observe a wall heater in the home (central heat). Off limit areas of the home: all bedrooms. Fire clearance granted for living room, kitchen, outside play area, bathroom, and garage area.

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, and no bodies of water. The Licensee's Assistant states that she does not have weapons in the home. Licensee states that she does not administer medications at this time. While touring the home LPA Macias observed toiletries (mouth wash, body wash, shampoo, conditioner, as well as a bath salts) accessible to the children. The items were in the bathroom the children utilize, in the shower/ tub floor, and unlocked cabinet under the sink. LPA Macias reviewed the importance of ensuring all chemicals/ toiletries remain inaccessible to the children. Explaining that poisons, detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours to ensure that the children are safe and supervised at all times. The Licensee understands the current capacity options and she understands that he cannot have more than 14 children in the home at any time, with a qualified assistant present. LPA provided the Licensee with the ratio/capacity chart for his reference. The Licensee states that she does transport children; and she understands that children cannot be left in parked vehicles unattended any time.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Joseph Macias
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

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: HARRIS, LAKISHA	FACILITY NUMBER: 434416177
	VISIT DATE: 07/08/2021

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LPA observed staff immunization records on file.

LPA also went over safe sleep for infants:

· Always place infants on their backs for sleeping.

· Use a tight-fitting sheet on the crib or play yard mattress.
· Do not hang any items from the crib or above the crib.
· Keep all items out of the crib or play yard.
· Pacifiers may be used as long as they do not have items attached to them.
· Infants should not be swaddled or have any items covering them while sleeping.
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.

A review of staff records on July 8, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. A $500 immediate civil penalty. An ongoing $100 per day per violation continues until the violation(s) is corrected. LPA discussed the requirements of AB633 to licensee and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and licensee understands the requirements.

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

The Licensee has completed the Mandated Reporter Training.

Type A deficiency cited, exit interview conducted, and a copy of this report was provided to the Licensee.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Joseph Macias
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/08/2021 10:37 AM - It Cannot Be Edited

Created By: Joseph Macias On 07/08/2021 at 10:13 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: HARRIS, LAKISHA	FACILITY NUMBER: 434416177
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/08/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/16/2021 Section Cited CCR 102417(g)(4)	1 2 3 4 5 6 7	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.	1 2 3 4 5 6 7	The Licensee will review regulations and submit a letter of understanding outlining a plan to prevent this from occurring again.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: the LPA observed toiletries (mouth wash, body wash, shampoo, conditioner, as well as a bath salts) accessible to the children. The items were in the bathroom the children utilize. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.	8 9 10 11 12 13 14	AB633 Parent Notification is required. This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Sandy Knight

LICENSING EVALUATOR NAME:

Joseph Macias

LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC809 (FAS) - (06/04)

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