434416489-8-25-2021-07-CC-JCRZ-C68PGD-20210825111810

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416489
Report Date: 08/25/2021
Date Signed: 08/25/2021 11:18:22 AM

Document Has Been Signed on 08/25/2021 11:18 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:	HARP, JENNIFER		FACILITY NUMBER:	434416489
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/25/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	JENNIFER HARP		TIME COMPLETED:	11:45 AM

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 Analysts (LPAs) Janette Cruz and Mel Matos conducted an announced prelicensing inspection with Jennifer Harp, Applicant. The purpose of today's tele-inspection: address the Application for a Small Family Child Care Home license (Change of Location) that the Applicant submitted to the Department on June 06, 2021. The Applicant is currently licensed at 728 Los Huecos Drive, San Jose, CA 95123 (Facility #434416149). Application/Record Review: The Applicant was the only one present in the home during today's inspection. The Applicant and Applicant’s brother, Kyle Harp, are the adults residing in the home. The Applicant also has 3 minor children: (daughter – age 6 and sons ages 3 and 4) residing in the home. Days and hours of operation will be Monday to Friday from 7:00 AM to 6:00 PM. The Applicant completed the Preventative Health and Safety Training with Lead Training on 07/11/2021 and a copy of the certification is on file. The Applicant has proof of Pediatric CPR and First Aid training with expiration date of 08/07/2023 on file. Applicant has updated vaccinations (including flu vaccine opt out) and proof of completion of the Mandated Reporter Training for Child Care Workers completed on 07/27/2021 on file. The Applicant rents the home and a copy of the lease agreement verifying control of property is on file. The completed Property Owner/Landlord Notification (LIC 9151) form is on file. Applicant states that she only intends to have up to six children in her day care. All individuals subject to a criminal record review (Applicant and Applicant's brother) have obtained a criminal record and child abuse index clearances prior to today's inspection. The Applicant agreed to give LPAs a tour of the home during today’s inspection. Physical Plant Tour : LPAs observed a single story home with four bedrooms, two bathrooms, living/ family room, kitchen with dining area, play room, and backyard. There is a working telephone in the home (cell #408-597-7879).

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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: HARP, JENNIFER	FACILITY NUMBER: 434416489
	VISIT DATE: 08/25/2021

NARRATIVE

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LPAs observed the home is clean and orderly, with centralized heating and ventilation for safety & comfort. There are no wall heaters inside the home. LPAs observed a screened fireplace unit in the family room. The off-limit areas inside the home are: one bedroom , one bathroom, and attached garage. Off-limit areas outside the home - right side of the yard where Applicant keeps her two dogs. There are safe and age appropriate toys, play equipment, and materials for the children in the home.

LPAs observed that the Applicant has designated an area in the family room where child(ren) can be isolated if exhibiting signs of illness. The home has one working smoke and carbon monoxide detector in the home. The Applicant has one fully charged fire extinguisher (2A10BC) inside the home. LPAs observed the Applicant has two large dogs (mix breed) and one cat in the home. Applicant states that there are no firearms or weapons in the home. All cleaning compounds and medications are adequately stored (high cabinets) and inaccessible to children. Applicant was reminded that any poison inside the home must be kept locked. The Applicant states that she does not have any baby walkers in the home. The Applicant understands that baby walkers are not allowed in the day care. The Applicant understands that high chairs are to be used only for eating purposes. The Applicant states that no adults smoke and she understands that smoking is prohibited in the home.

Kitchen tour: LPAs observed the refrigerator and freezer in the home are clean. There are no sharp utensils, cleaning products, lighters/matches, or open bottles of alcohol accessible to children. The Applicant understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated.

Bathroom tour: LPAs observed the bathroom toilet and faucet are clean, safe, and operable. All shampoos, soap, medication, mouthwash, perfumes, razors, cleaning products, air fresheners, and nail polish/remover are inaccessible to the children.

Outdoor tour: LPAs observed the outdoor backyard area of the home is fenced and secure for the children. LPAs observed one side of the fence was wobbly and needs repair of one of the fence panel. LPAs observed an air conditioner condenser unit at the backyard that is accessible to children. Licensees state that the A/C condenser is not in use. The backyard has artificial grass. There are no bodies of water on the property.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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: HARP, JENNIFER	FACILITY NUMBER: 434416489
	VISIT DATE: 08/25/2021

NARRATIVE

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Document/Regulation Review: A Family Child Care Home packet with updated Licensing forms was mailed to the Applicant prior to today's inspection and the Applicant acknowledged receipt of the packet. Documents from the packet were discussed and reviewed with the Applicant. COVID-19 required postings/resource/self-assessment information were provided to the Applicant. COVID-19 self-assessment also completed during today's tele-inspection.

Applicant stated that forms of discipline that will be used is "talking to children." The Applicant understands that children's personal rights should not be violated. The requirements for assistant/substitute were also discussed with the Applicant during today's inspection.

Incidental Medical Services (IMS) policy was discussed with the Applicant during today's tele-inspection. 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.

LPAs discussed with Applicant the requirements of LIC 995B Family Child Care Home Addendum to Notification of Parents Rights. LPAs advised that LIC 995B forms will be mailed to Applicant. The Applicant understands that a separate LIC 995B must be provided to all parents/guardians of enrolled children for each excluded individual. The LIC 995B forms must be signed by all parents/guardians and placed in each child’s file.

Notification requirements: LPAs discussed the requirements of AB 633 with the Applicant. The Applicant understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224).

LPAs conducted an exit interview and advised the Applicant that a small Family Child Care Home license will be approved upon completion of the following:
1. Proof of repairs of the fence.
2. Photo of safety cover for the A/C condenser unit.
3. Review and approval by LPAs manager.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

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