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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700070
Report Date: 12/13/2023
Date Signed: 12/13/2023 03:24:58 PM

Document Has Been Signed on 12/13/2023 03:24 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MACADAAN, JENNIFERFACILITY NUMBER:
015700070
ADMINISTRATOR:MACADAAN, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 520-5261
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 10DATE:
12/13/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Jennifer Macadaan- LicenseeTIME COMPLETED:
03:35 PM
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On 12/13/23, Licensing Program Analyst (LPA) Briana Plumboy conducted an unannounced Inspection with Licensee Jennifer Macadaan. Present for the inspection was 1 infant, 9 preschool age children in care as well as licensee's fingerprint clear and associated mother Erlinda Abrigo and licensee's partner Oscar Batres. The home was toured by LPA Plumboy along with the licensee. Hours of operation for day care are Monday through Friday, 6:00am until 6:00pm.

The home is two stories. The home consists of 3 bedrooms, 1 master bedroom/bathroom, 2 hallway bathrooms, a living room/dining room combo, garage, a kitchen, and a foyer. The home is clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the foyer, kitchen, garage, and entire second story of the home which will be inaccessible by closed and/or locked doors and visual supervision. There is a child safety gate located at the base of the stairs to prevent access to children under the age of 5 years old. The children enter the home through the foyer, walk through the kitchen, and then enter into the childcare area. When the children walk through the foyer and kitchen they must be supervised at all times. There is a child safety gate located between the kitchen and dining room/living room combo. The ON LIMIT AREAS are the living/dining room combo, downstairs bathroom, the downstairs bedroom located next to the bathroom, and backyard section 1 which is located down 2 steps off the living room. The ISOLATION AREA will be a couch in the dining room. Outdoor play area will be in the fenced backyard. The outdoor play area has 2 sections. The section the children play in is backyard 1 which is located down 2 steps off the living room, and backyard 2 is off limits to children in care and located behind the fence. The outside play area is enclosed with ventilation for the children to have fresh air and padding on the ground.

There is a 3A40BC fire extinguisher, carbon monoxide detector, pull down fire alarm, and smoke detector.
Per licensee, there are no firearms in the home. All required licensing documents are posted and visible for public review. The licensee's Pediatric CPR/First Aid certificate is expired. Licensee's mandated reporter training was completed on 1/2/22 and Oscar Batres' was completed on 6/1/22. Licensee and assistants present are in compliance with the immunization law. The licensee conducts and documents fire and disaster drills at least twice a year with the last one conducted on 8/24/23. The facility has current daycare insurance. The licensee is in ratio today. See 809-C and 809-D for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MACADAAN, JENNIFER
FACILITY NUMBER: 015700070
VISIT DATE: 12/13/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Child Care Centers and Family Child Care Homes: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.



To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Family Child Care Homes Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

See 809-C and 809-D for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MACADAAN, JENNIFER
FACILITY NUMBER: 015700070
VISIT DATE: 12/13/2023
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The licensee provided proof of control of property.


LPA discussed the safe sleep regulations with and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility.

A notice of site visit was given and must remain posted for 30 days.

See 809-D for deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Jennifer Macadaan.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/13/2023 03:24 PM - It Cannot Be Edited


Created By: Briana Plumboy On 12/13/2023 at 02:49 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MACADAAN, JENNIFER
FACILITY NUMBER: 015700070

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by not documenting each 15-minute check for infants which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/29/2023
Plan of Correction
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 Licensee will begin using these sleep logs on all infants birth to 24 months, monitoring and recording 15 minute checks and keep the records for 3 years. Each Friday in December 2023, licensee will submit her sleep log to LPA Plumboy.
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 record review, the licensee did not comply with the section cited above due to her CPR certificate being expired which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2023
Plan of Correction
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The Licensee will submit proof of enrollment in an approved CPR/First Aid course, to LPA by email, fax or mail by 12/20/23.
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:Wynn Norona
LICENSING EVALUATOR NAME:Briana Plumboy
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023


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