Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409221
Report Date: 03/14/2019
Date Signed 03/14/2019 04:43:03 PM

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:LARA, GABRIELAFACILITY NUMBER:
434409221
ADMINISTRATOR:GABRIELA LARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 843-8720
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 9DATE:
03/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Gabriela LaraTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual random inspection to the home today. LPA met with Gabriela Lara, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 8:00 AM to 5:000 PM. The adults that reside in the home are the Licensee and her spouse Gumercindo. LPA observed there were nine children in care during today's inspection, included two infant children and seven preschool age children. Licensee and Licensee's helper, Dora, have certifications for CPR and First Aid are current and will expire on 5/11/2020 and 12/16/2019 respectively. Present today in the home was Licensee's husband Gumercindo and Licensee's helper Dora.
LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the Child Care Facility Roster during today's inspection and it is current. LPA reviewed the Fire/Disaster drill log during today's inspection and it is current, last fire drill was documented on 11/25/2018. The Licensee has a working telephone (landline) in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. LPA observed there are not wall heaters in the home. Off limit areas in the home are all the second floor, and the laundry room and garage in the first floor. LPA observed there are barricaded stairs in the home. Off limits area out side is the back yard where the Licensee keeps a small dogs. Licensee stated the dogs are vaccinated. LPA observed the back yard is off limits and it is fenced. LPA observed there is a fenced pool in the back yard. LPA observed Licensee keeps locked the access to the back yard.
LPA observed a fully charged 3A40BC fire extinguisher, working smoke detectors and no bodies of water. LPA observed a working carbon monoxide detector in the home. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.
LPA discussed Incidental Medical Services (IMS) with the Licensee. Licensee has submitted before proof of having immunization for herself, for influenza, pertussis, and measles. Licensee's helper has a signed statement as proof of immunization for measles, pertussis, and opt out declaration for influenza.
****************************************Report dated 3/14/2019 continues in page 2.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2019
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 2
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: LARA, GABRIELA
FACILITY NUMBER: 434409221
VISIT DATE: 03/14/2019
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Report dated 3/14/2019 continues from page 1.

A review of staff records on 3/08/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a helper must be present. Licensee understands that in absence of a helper her license capacity is reduced to only 8 children. The Licensee states that she does not transport children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.
LPA provided licensee with the forms LIC279, LIC279B, and LIC999A for licensee updating the license information.

Department website: www.ccld.ca.gov provided to Licensee.

LPA also discussed "zero tolerance" related regulations with the Licensee. LPA informed Licensee of the required "mandate reporter" training (AB1207) which is mandatory for all licensees and adults in contact with children. LPA referred Licensee to the website: www.ccld.ca.gov for taking the training and for obtaining information.

There were no deficiencies cited during the inspection. Appeal rights was printed and given to Licensee. Exit interview was done in Spanish with Licensee.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2