Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411478
Report Date: 11/16/2017
Date Signed 11/17/2017 04:25:57 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:GARCIA, MARIAFACILITY NUMBER:
434411478
ADMINISTRATOR:GARCIA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 665-5792
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 4DATE:
11/16/2017
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Maria GarciaTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Tony Studebaker conducted an unannounced, Required - 3 Year, inspection on today's date. LPA met with the Licensee and explained the nature of today's inspection. There were 4 day care children present during the inspection along with the Licensee and an assistant. The adults that reside in the home are the Licensee and 3 additional adults. They all have fingerprint clearance. There are also 2 minor children that live in the home. Days and hours of operation are Monday through Friday 5:30 AM to 4 PM. Licensee's Pediatric CPR and first aid card is current. CPR and first aid card expires 11/2018. LPA verified all required postings are posted and available for review.

LPA toured the indoor and outdoor areas of the home. Fire drills are conducted at minimum every six months when children are in care. Smoke detector, carbon monoxide detector, and fire extinguisher were noted. The roster is current and up to date. The Licensee has a working telephone and the phone number is (408) 665-5792. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters inside the home. Fireplace is guarded with a screen. The Licensee is aware that the temperature must always be monitored and comfortable for all children. No stairs noted. There are pets in the home. The pets are vaccinated. The backyard is fenced. There are no bodies of water. The Licensee states that she does not have any weapons in the home. All poisons, detergents, cleaning supplies, medications, and other similar items are inaccessible to children. LPA reminded the Licensee that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in family child care homes.

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SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Anthony StudebakerTELEPHONE: (408) 334-8553
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2017
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: GARCIA, MARIA
FACILITY NUMBER: 434411478
VISIT DATE: 11/16/2017
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Supervision of children was discussed with the Licensee. Licensee stated she is present in the home 100 percent of the hours the day care is in operation and ensures that the children are supervised at all times. The Licensee understands her capacity options. Random sample of child records were reviewed and found to be in order including the Notification of Parents' Rights. Licensee uses talking as discipline.

The Licensee states that she does transport children via vehicle and understands the seat belt care seat law and that children cannot be left in parked vehicles unattended at any time.

A review of staff records today indicate 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 discussed and reviewed immunization requirements including Measles, Pertussis, and Influenza. 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.

Off limit areas include all of the bedrooms, laundry room, back yard, and side yard.

Incidental Medical Services (IMS) policy was discussed with the Licensee. No medications are given by the Licensee at this time. For IMS information see Evaluator Manual - Regulations 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.

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SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Anthony StudebakerTELEPHONE: (408) 334-8553
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2017
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: GARCIA, MARIA
FACILITY NUMBER: 434411478
VISIT DATE: 11/16/2017
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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

Disaster plan was reviewed with the Licensee and Licensee stated that all information remains current. LPA discussed Safe Sleep with the Licensee and provided a copy of "A Child Care Provider's Guide to Safe Sleep."

Licensing Forms, Title 22 Regulations, and information can be obtained through the internet at www.cdss.ca.gov.

No deficiencies were issued during the inspection. Exit interview conducted with the 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: Timetra FaulconTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Anthony StudebakerTELEPHONE: (408) 334-8553
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2017
LIC809 (FAS) - (06/04)
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