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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416489
Report Date: 06/12/2024
Date Signed: 06/12/2024 10:31:39 AM

Document Has Been Signed on 06/12/2024 10:31 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, JENNIFERFACILITY NUMBER:
434416489
ADMINISTRATOR/
DIRECTOR:		JENNIFER HARPFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 597-7879
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 14TOTAL ENROLLED CHILDREN: 16CENSUS: 12DATE:
06/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Jennifer HarpTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analysts (LPAs), Cortney Nelson and Liridon “Doni” Fici, met with the Licensee, Jennifer Harp, and explained purpose of the visit. Upon arrival, LPAs were admitted into the family child care home (FCCH) by Jennifer.

A visit was conducted by the San Jose Police Department to Jennifer’s FCCH on 12/4/2023 and excluded individual, Lisa Pollay, was present at the home caring for day care children. Based on available evidence, it has been concluded that Lisa assists at the FCCH and transports day care children. Excluded individuals are not permitted to be in the home at any time when children are in care.

When investigator (Inv.) Victoria McIntosh arrived to Jennifer’s FCCH on 3/7/2024, it was observed that thirteen (13) day care children were being cared for by a minor (S1). No additional adults were present in the home until Jennifer arrived a few minutes later with two of her own minor children. There was a total of fifteen (15) day care children present at that time, which is over the FCCH maximum capacity of fourteen children.

Inv. McIntosh reviewed Jennifer’s children’s files during visit on 3/7/2024 and observed that four (4) out of thirteen (13) enrolled children had files. Additionally, it was observed that one (1) out of four (4) files reviewed had a signed copy of Addendum to Notification of Parents Rights (Regarding Removal/Exclusion) (LIC995B) for Lisa Pollay and David Stewart. The facility roster (LIC9040) was not up to date and Inv. McIntosh requested Jennifer update it for all children currently enrolled at the FCCH. An updated facility roster was received on 3/10/2024.

It has additionally been identified that an individual (S2) attends and resides at Jennifer’s FCCH and has not obtained a criminal record clearance or exemption. Pursuant to Health and Safety Code 1596.871, any person residing in the home shall obtain criminal record clearance or exemption prior to initial presence in the FCCH.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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: 06/12/2024
NARRATIVE
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LPAs informed licensee (Jennifer Harp) that this report dated (6/12/2024) documents five (5) Type A citations which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs informed the licensee to provide a copy of this licensing report dated (6/12/2024) that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

As a result of todays inspection, deficiencies were cited, see LIC809-D.

Exit interview conducted and the report was reviewed with the Licensee, Jennifer Harp.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.

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

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 06/12/2024 10:31 AM - It Cannot Be Edited


Created By: Cortney Nelson On 06/12/2024 at 08:57 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: HARP, JENNIFER
FACILITY NUMBER: 434416489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
06/13/2024
Section Cited
HSC
1596.8897(g)

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HSC 1596.8897 Prohibited positions or employment; grounds; notice; removal; appeal; petition for reinstatement (g) A licensee's failure to comply with the department's exclusion order after being notified of the order shall be grounds for disciplining the licensee...

This requirement was not met as evidenced by:
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The Licensee shall submit written statement that she understands Lisa Pollay shall not be present at the day care during operating hours. Statement to be submitted to the Department by 6/13/2024.
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Based on evidence obtained, the Licensee did not remove excluded individual, Lisa Pollay, and allowed Lisa to assist at the FCCH and transport day care children, which poses an immediate risk to the health, safety, and personal rights of children in care.
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-Civil penalty assessed-
Type A
06/13/2024
Section Cited
CCR102416.5(a)

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102416.5 Staffing Ratio and Capacity (a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

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The Licensee shall submit schedule for the children currently enrolled at the day care home and the staff that will be present to ensure that staff/child ratio is met.
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Based on observation by Inv. McIntosh, the Licensee did not follow capacity requirements during visit on 3/7/2024 as a minor assistant (S1) was present at the FCCH with thirteen (13) children in care, which poses an immediate risk to the health, safety, and personal rights of children in care.
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The schedule shall contain names of the children and the days/times that they attend the day care home. Schedule with staffing shall be submitted to the Department by 6/13/2024.
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: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 06/12/2024 10:31 AM - It Cannot Be Edited


Created By: Cortney Nelson On 06/12/2024 at 09:02 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: HARP, JENNIFER
FACILITY NUMBER: 434416489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/13/2024
Section Cited
CCR
102417(a)

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102417 Operation of a Family Child Care Home (a) The Licensee shall...ensure that children in care are supervised at all times. When circumstances require the Licensee to be temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence...

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The Licensee will submit written plan detailing what adults will be present with children when the Licensee is absent from the day care home. Names of the adults and copy of their ID to be submitted with the written plan.
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Based on observation by Inv. McIntosh, the Licensee did not arrange for a substitute adult to care for day care children as a minor assistant (S1) was alone with thirteen (13) day care children on 3/7/2024, which poses an immediate risk to the health, safety, and personal rights of children in care.
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Plan to be submitted to the Department by 6/13/2024.
Request Denied
Type A
06/13/2024
Section Cited
CCR102370(d)(1)

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102370(d)(1) Criminal Record Clearance (d) All individuals subject to a criminal record review ...shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption...

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The Licensee shall obtain criminal record clearance or exemption for S2. Proof of completed Livescan (LIC9163) to be submitted to the Department by 6/13/2024.
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Based on the available evidence, the Licensee did not obtain a criminal record clearance or exemption for an individual (S2) that attends and resides at the FCCH, which poses an immediate risk to the health, safety, and personal rights of children in care.
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-Civil penalty assessed-
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: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/12/2024 10:31 AM - It Cannot Be Edited


Created By: Cortney Nelson On 06/12/2024 at 09:05 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: HARP, JENNIFER
FACILITY NUMBER: 434416489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/13/2024
Section Cited
HSC
1596.8712(b)(1)

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1596.8712 Exclusion of Individual from Licensed family day care home; notice (b)(1) Immediately upon receipt of an addendum from the department, the licensee shall provide the parent or guardian of each child under the licensee’s care or supervision with a copy of the addendum identifying the excluded individual or individuals. The licensee shall also obtain the signature of the parent or guardian indicating that the parent or guardian has received a copy of the addendum. A signed copy... shall be retained by the...provider, and provided to the department during the regular inspection of the home...
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The Licensee will provide copies of the LIC995B for Lisa Pollay and David Stewart to parents or guardians of children in care and obtain signatures. Copies to be submitted to the Department by 6/13/2024.
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This requirement was not met as evidenced by:

Based on record review and observation by Inv. McIntosh, the Licensee did not obtain signature from the parent or guardian on the LIC995B regarding Lisa Pollay or David Stewart for twelve (12) out of thirteen (13) enrolled children, which poses an immediate risk to the health, safety, and personal rights of children in care.
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-Civil penalty assessed-

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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: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 06/12/2024 10:31 AM - It Cannot Be Edited


Created By: Cortney Nelson On 06/12/2024 at 09:09 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: HARP, JENNIFER
FACILITY NUMBER: 434416489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2024
Section Cited
HSC
1596.841

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1596.841 Current roster of children provided care in facility required Each child day care facility shall maintain a current roster of children who are provided care in the facility... This roster shall be available to the licensing agency upon request.

This requirement was not met as evidenced by:
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POC has been cleared, the Licensee submitted an updated facility roster to Inv. McIntosh.
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Based on record review and interview conducted by Inv. McIntosh, the Licensee did not maintain a current roster of children who are provided care, which poses a potential risk to the health, safety, and personal rights of children in care.
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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: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024


LIC809 (FAS) - (06/04)
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