102417(g)(7) · Operation of A Family Child Care Home (7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. Child 7 is missing LIC627 which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/10/2024

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

102419(d)(1) · Admission Procedures and Authorized Representatives Rights (d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. Child 1, 2, 3, 4, 5, 6, 8, 9, 10, and 11 are missing LIC995 which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/10/2024

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

102417(g)(4) · Operation of A Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, licensee had shampoo and medicine accessible to children in care, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 09/22/2022

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

102417(g)(4)(A) · Operation of A Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, accessible medicine cabinet has no lock, storage shed gate has a malfunctioning latch where chemical are being stored, 12 inch hunting knife found in dining room hutch accessible to children, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 09/22/2022

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

102418(a) · Immunizations (a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above, licensee states Child 1 (C1) has not been immunized, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 10/21/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

102417(b) · Operation of A Family Child Care Home (b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above, in on limit area of back yard, unopened beer cans were visible on right side fence, bird cage with food scattered on floor attracting rodents, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 10/05/2022

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

102421(b) · Child's Records (b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7).

Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above, Child 4 (c4) and c6 form is complete but signature parent signature is missing, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 10/05/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

102419(d)(1) · Admission Procedures and Authorized Representatives Rights (d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above, child 2 (c2), c4 and c9 file has missing signed LIC 995A, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 10/05/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

102425(c) · Infant Safe Sleep An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above, child 1 (c1) and c2 files have no LIC 9227 on file, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 10/05/2022

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

102416.3(a)(6) · Violation

Alterations to Existing Buildings or Grounds (a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above, licensee converted the garage to living quarters and added a third bedroom without notifying the San Jose Regional Office for fire clearance, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 10/05/2022

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.