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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416407
Report Date: 11/18/2022
Date Signed: 11/18/2022 03:15:55 PM

Document Has Been Signed on 11/18/2022 03:15 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BRUCE, KIMBERLYFACILITY NUMBER:
444416407
ADMINISTRATOR:KIMBERLY, BRUCEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 313-5690
CITY:SCOTTS VALLEYSTATE: CAZIP CODE:
95066
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 7DATE:
11/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:22 PM
MET WITH:Kimberly BruceTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Licensee, Kimberly Bruce, for an unannounced Required- 1 Year Inspection. LPA was granted access to the home by Assistant, Makenzie, and toured both indoors and outdoors during the inspection. Upon arrival, there were seven (7) children (3 preschool-age/ 4 infants), the Licensee, and Assistant (Makenzie) present, which is compliant with the home license capacity and ratio requirements. LPA observed all required postings near the entrance to the home and the hours of operation are Monday – Friday, 8:00AM-5:00PM.

Licensee states that adults, over the age of 18, residing in the home are: herself, her spouse (Jason), her daughter (Mackenzie), and her son (Brody). All adults residing in the home have Criminal Background Check Clearance and signed Criminal Record Statements (LIC508).

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.

LPA reviewed facility roster (LIC9040) and fire/disaster drill log during todays inspection. The last fire/disaster drill was conducted on 10/28/2022, which is compliant with the six-month requirement for homes. LPA observed a fully charged 3A40BC fire extinguisher, functioning smoke detector and carbon monoxide detector. The Licensee states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. The Licensee states that there are no weapons or firearms in the home.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2022
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BRUCE, KIMBERLY
FACILITY NUMBER: 444416407
VISIT DATE: 11/18/2022
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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 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

Indoor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Off-limits areas inside the home include: the entire downstairs area, detached garage, laundry room, and kitchen. There are no open-faced heaters in the home. During todays inspection, LPA observed day care children napping following the infant safe sleep regulations and quietly playing with the Licensee/Assistant. LPA observed sufficient age-appropriate materials, toys, and play equipment in the home. Drinking water is readily available for children in the home via filtered water and color coded sippy cups. The bathroom in the home is clean, sanitary, and operable. The Licensee has a working telephone in the facility. Stairs are barricaded appropriately to keep day care children safe.

The outside area of the home was inspected and observed to be not in use today due to resealing of the deck. The Licensee states that she will resume using the deck after the holiday break. LPA observed sufficient play-equipment and supplies for the children that are in good condition and age-appropriate. Off-limit areas outside of home include: everything outside of the fenced deck (yard, side deck). No outdoor bodies of water were observed during todays inspection.

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 advised the Licensee that sleep saks are not allowed and will require an exception per individual child to continue use in the FCCH. The Licensee states that she will discontinue use of the sleep sak and instead provide standard clothes to keep the infant warm during napping.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
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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: BRUCE, KIMBERLY
FACILITY NUMBER: 444416407
VISIT DATE: 11/18/2022
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7 children’s files were reviewed during todays inspection and all required documents were present, including Individual Infant Sleep Plan (LIC9227) and sleep check documentation for all infants.

The Licensee, Assistant, and Home Resident files were reviewed and most required documents were present. The Licensee's CPR/First-Aid expired on 7/19/2022. The Licensee has current Mandated Reporter Training that expires on 9/26/2023 and LPA reminded that training must be renewed by all staff every 2 years.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The Licensee states that she does not transport any day care children. LPA reminded Licensee that children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Exit interview conducted and report was reviewed with the Licensee, Kimberly Bruce.

As a result of todays inspection, a deficiency was cited, see 809-D.

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.

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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
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Document Has Been Signed on 11/18/2022 03:15 PM - It Cannot Be Edited


Created By: Cortney Nelson On 11/18/2022 at 02:56 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: BRUCE, KIMBERLY
FACILITY NUMBER: 444416407

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above for herself and her assistant (Makenzie) as their CPR/First-Aid expired on 7/19/2022, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2022
Plan of Correction
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The Licensee will submit proof of registration or completion of CPR/First-Aid course by 12/1/2022 to the Department.
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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2022


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