<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416407
Report Date: 08/26/2021
Date Signed: 08/26/2021 11:58:58 AM

Document Has Been Signed on 08/26/2021 11:58 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:BRUCE, KIMBERLY & PAYTONFACILITY NUMBER:
444416407
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Kimberly BruceTIME COMPLETED:
12:10 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
#2 Licensing Program Analysts (LPAs) Cortney Nelson and Marilou Monico conducted an unannounced Required - 1 Year inspection and in response to a request to add the deck and den areas on-limits for children. LPAs met with Licensee, Kimberly Bruce, and explained the purpose of today's visit. Also present in the home were Licensee, Payton Bruce, and six daycare children including two infants and four preschool age. There are five adults residing in the home: Both licensees, Kimberly's husband, and Kimberly's two children. The daycare is open Monday thru Friday from 8:00 AM to 5:00 PM.

The indoor and outdoor areas were inspected. There is a 3A40BC fire extinguisher that needs to be recharged. There were no bodies of water observed. Off limit areas in the home: entire downstairs areas except the deck, detached garage, kitchen (main floor), and laundry room (main floor). Off limit areas outside the home: entire outdoor areas except the two decks. Cleaning compounds, sharp objects, and other similar items were stored inaccessible to children. Licensee maintains a current children's roster. The last fire/disaster drill was conducted on May 5, 2021. Per licensee, there are no weapons in the home. Five children's files were reviewed. Both licensees have current Pediatric CPR/First Aid certifications. LPAs obtained a copy of children's roster during the inspection.

LPAs discussed Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reporter Training can be accessed at www.mandatedreporterca.com. Payton's Mandated Reporter Training expires on August 28, 2021, Kimberly's Mandated Reporter Training expired on April 4, 2020 and her husband who helps with the daycare has not completed the training. AB 633 was discussed with Licensee. Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov.
Continuation on next page:
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2021
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 3
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 & PAYTON
FACILITY NUMBER: 444416407
VISIT DATE: 08/26/2021
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
26
27
28
29
30
31
32
LPAs reviewed with Kimberly and provided her a copy of Safe Sleep Regulations (PIN 20-24-CCP).

A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Incidental Medical Services (IMS) was discussed. Licensee stated that she's not planning to provide IMS at this time.

Licensee to submit photos showing that the gap between the flooring and fence on the deck area downstairs where infants will be playing has been barricaded prior to using the space for daycare purposes. The other area of the deck can now be used as an outdoor space for preschool age children.

In addition, licensee was advised to submit updated facility sketch to show the emergency exit routes, location of utility shut offs and fire extinguisher.

As a result of this inspection, deficiencies were cited on the following page:

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/26/2021 11:58 AM - It Cannot Be Edited


Created By: Cortney Nelson On 08/26/2021 at 10:43 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: BRUCE, KIMBERLY & PAYTON
FACILITY NUMBER: 444416407

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/09/2021
Section Cited
CCR
102417(g)(1)

1
2
3
4
5
6
7
Operation of a Family Child Care Home - The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
1
2
3
4
5
6
7
Kimberly states she will submit proof of purchase of a fully charged 2A10BC fire extinguisher or larger by 09/09/21.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: LPAs observed that the 3A40BC fire extinguisher needs to be recharged. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
Type B
09/27/2021
Section Cited
HSC1596.8662(4)(b)(1)

1
2
3
4
5
6
7
On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
1
2
3
4
5
6
7
Kimberly states she will submit proof of current Mandated Reporter Training certifications for her and her husband by 09/27/21.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Kimberly's Mandated Reporter Training certificate expired on 04/09/20 and her husband who helps with the daycare has no proof of completion.
8
9
10
11
12
13
14
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:Anthony Studebaker
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2021


LIC809 (FAS) - (06/04)
Page: 3 of 3