Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620268
Report Date: 07/07/2017
Date Signed 07/10/2017 08:21:46 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:JURAN, MELANIEFACILITY NUMBER:
393620268
ADMINISTRATOR:JURAN, MELANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 407-6068
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY:14CENSUS: 7DATE:
07/07/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Melanie JuranTIME COMPLETED:
03:15 PM
NARRATIVE
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(2)Licensing Program Analyst (LPA) Mary Ponce and Licensing Program Manager Monica Filice met with Christopher Juran and Licensee for an unannounced annual inspection. The facility operations Mon-Fri 6:00AM to 6:00PM. LPA toured all areas of the home that are accessible to the children. A current roster of children, capacity and ratio were observed. When LPAs arrived, Chris was present with 7 daycare children. Licensee arrived later during the visit. LPA confirmed that all adults residing or working in the home have criminal record clearances. LPA advised licensee if anyone over the age of 18 years old moves into the home they must have a criminal record clearance as well. LPA observed posting of the license, Parent's Rights and the current disaster plan. During the visit, LPA observed an open shed with paints, yard tools and other tools. LPA advised Christopher to ensure it is locked during business hours.
Off-limit areas include: Garage, Laundry Room, and Master Bedroom. Licensee acknowledged that children may never enter these off-limit areas. The backyard is fenced and licensee acknowledges that children may never be left unsupervised in an unfenced area of the yard. LPA observed a kiddie pool being used for dogs. LPA advised licensee the requirements of use of pools. Pool was dumped during today's visit. Licensee stated there are no weapons in the home.

LPA observed current CPR and First Aid certificates that expires on 12/17/18. Licensee's husband Christopher was unable to provide proof of CPR/ First Aid Training during visit. LPA observed that poisons are locked, smoke detector and carbon monoxide detector meets regulation as well as fire extinguisher. Fireplace is inoperable, cleaning materials, hazardous items and medications are all inaccessible to children. LPA observed a Fire Drill Log and the licensee is conducting fire drills at least every six months. There is a working telephone,
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2017
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: JURAN, MELANIE
FACILITY NUMBER: 393620268
VISIT DATE: 07/07/2017
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. Licensee stated she does not administer IMS. 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

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPAs also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list. childcareadvocatesprogram@dss.ca.gov

Deficiencies cited on the next page. Notice of Site Visit was posted and an exit interview was conducted
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2017
LIC809 (FAS) - (06/04)
Page: 2 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: JURAN, MELANIE
FACILITY NUMBER: 393620268
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2017
Section Cited
102416(c)
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Personnel Requirements. 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.
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Licensee states husband has Current CPR/ First Aid training, but was unable to provide proof. Licensee will submit cards to LPA by POC July 14th, 2017
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When LPAs arrive, Licensee's husband was alone with children and was not able to produce a current CPR/ First Aid Training.
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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: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2017
LIC809 (FAS) - (06/04)
Page: 3 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: JURAN, MELANIE
FACILITY NUMBER: 393620268
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/07/2017
Section Cited
102417(g)(5)
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Operation of a Family Child Care Home. All pools, spas, hot tubs, fish ponds, or similar bodies of water shall be covered or fenced as specified to be inaccessible to children.
LPA and LPM witnessed a filled Kiddie Pool that was being used for the dogs. This is a zero tolerance and civil penalty assessed during visit.
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Licensee dumped water during inspection and deficiency was cleared. Licensee said they will not use it or will empty it out once done.
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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: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2017
LIC809 (FAS) - (06/04)
Page: 4 of 4