434416742-9-22-2022-07-CC-SYIP-CJHKPT-20220922080512

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416742
Report Date: 09/20/2022
Date Signed: 09/22/2022 08:05:30 AM

Document Has Been Signed on 09/22/2022 08:05 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:	WALL, JILL		FACILITY NUMBER:	434416742
ADMINISTRATOR:	JILL WALL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 981-4148
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 13	DATE:	09/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:11 AM
MET WITH:	Jill Wall		TIME COMPLETED:	01:15 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) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Licensee Jill Wall and explained the reason for the inspection. Present during today's inspection were Licensee, one assistant, and 13 children, whom one is home schooled. Licensee stated that she will submit proof that child is enrolled and attending home-school- Ocean Grove. LPA discussed with Licensee about ensuring that there is an area to post required postings, such as license and notification of parents. The hours of operation are Monday through Thursday 9AM to 12PM. LPA toured the inside and outside of the home. The off-limit areas inside of the home are all four bedroom, kitchen, living room, family room, and garage. The stairs inside of the home are barricaded. Disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to inaccessible. LPA reminded Licensee that anything that states to keep out of reach of children needs to be inaccessible, such as disinfectant wipes. There are toys and equipment for children. Licensee uses the outside area for daycare children. The last fire/disaster drill was conducted on 09/12/2022. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Licensee stated that there are no weapons, such as firearms, stored in the home. The backyard is used and is fenced. The off-limit area outside of the home is the grass/hill area. There is play structure that is anchored to the ground. LPA observed that there are stairs that go from the side gate to the play yard, deck, and grass area that was not barricaded. LPA discussed with Licensee that stairs need to be barricaded at all time. There was no bodies of water observed during today's inspection. --------------------continues on 809 dated 09/202/2022 page 2--------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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: WALL, JILL	FACILITY NUMBER: 434416742
	VISIT DATE: 09/20/2022

NARRATIVE

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------------------continuation of 809 dated 09/20/2022 page 1---------------------

Licensee only cares for children 2 years old to 6 years old. 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 does provide Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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: http://www.ada.gov/childqanda.htm

A copy of the facility roster was obtained. Seven (7) children's files were reviewed during today's inspection. The records reviewed include but not limited to parent's rights, Affidavit regarding Liability insurance, and immunization records. LPA reminded Licensee to ensure that parents are filling out their child's name on the parent's rights and Affidavit Regarding Liability Insurance is signed. C-2's parent needs to sign and date the Affidavit Regarding Liability Insurance. C-1 attends Ocean Grove Charter School. LPA reminded Licensee to have proof on file.

------------------continues on 809 dated 09/20/2022 page 3------------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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: WALL, JILL	FACILITY NUMBER: 434416742
	VISIT DATE: 09/20/2022

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-----------------continuation of 809 dated 09/20/2022 page 2-------------------

Licensee's records are on file. Licensee's immunization records are on file. Licensee has a valid CPR/1st Aid, which expires on 04/17/2023. Licensee and her assistant completed the Mandated Reporter training. Licensee completed it on 08/25/2021 and her assistant completed it on 07/25/2022. LPA discussed with Licensee about the forms/documents that are required for any employees. A-1 filled out LIC 508 and LIC 9108 during today's inspection. A-1 is missing Immunization records for Measles, pertussis, and influenza, and TB test results.

The adults 18 years and older living in the home are Licensee and her spouse. Licensee also has three minor children. All adults have cleared fingerprints or exemption. 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.

Licensee will submit the following:
- proof that stairs are barricaded
- A-1's TB test and Immunization Records for measles, pertussis, and influenza

As a result of this inspection, Type B citations, technical violation, and technical assistant were issued. Exit interview was conducted and report was reviewed with Licensee Jill Wall. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/22/2022 08:05 AM - It Cannot Be Edited

Created By: Samantha Yip On 09/20/2022 at 12:36 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: WALL, JILL	FACILITY NUMBER: 434416742
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(3)

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: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded. 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 , which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/27/2022
	Plan of Correction
1 2 3 4	Licensee will send proof that stairs outside are barricaded.

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:

Joel Segura

LICENSING EVALUATOR NAME:

Samantha Yip

LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC809 (FAS) - (06/04)

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