274415885-9-9-2019-07-CC-FCJO-BFUTPZ-20190909145510

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274415885
Report Date: 09/06/2019
Date Signed: 09/09/2019 02:55:21 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:	PICENO GARCIA, VIVIANA		FACILITY NUMBER:	274415885
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	09/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Viviana Piceno Garcia		TIME COMPLETED:	12:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual random and increase of capacity inspection to the home today. Licensee has obtained a granted Fire Department clearance on 8/22/2019. LPA met with Viviana Piceno, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Sunday from 3:00 AM to 2:00 AM. Licensee stated the adults that reside in the home are the Licensee, her spouse Angel, her son Alberto, her uncle Esteban, and her aunt Amada. Licensee minor children ages 8 and 3 (present) also reside in the home. LPA observed there were six children in care during today's inspection, included one infant and five preschool age children, and included licensee's minor 3 years old. Certification for CPR and First Aid Card for Licensee is current and will expire on 2/3/2020. LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the children's roster today and it is current. LPA reviewed five children files and observed files are complete. LPA observed that Licensee has conducted a fire drill during the last six months. Last fire drill was documented on 8/05/2019. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: Four bedrooms, one bathroom, an the attached garage. LPA observed the laundry area is located in the off limits garage. Off limits areas outside: Left side yard, and a storage shed in the back yard. LPA observed the back yard is fenced, Licensee uses the back yard as playground for the children in care. LPA observed a fully charged 3A40BC fire extinguisher and at least one working smoke detector. LPA observed the home has a carbon monoxide detector. LPA observed there are not stairs in the home. LPA observed the home does not have wall heaters, or bodies of water. LPA observed the home has a barricaded fireplace in the on limits dining area. Licensee stated she does not have any pets. 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 with licensee. *******************Report dated 09/06/2019 continues in page 2.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

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: PICENO GARCIA, VIVIANA	FACILITY NUMBER: 274415885
	VISIT DATE: 09/06/2019

NARRATIVE

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Report dated 09/06/2019 continues from page 1
According with the SB792, Licensee has proof of immunization for herself for pertussis, measles, and influenza. A review of staff records on 09/05/2019 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 current capacity options and she understands that she cannot have more than 8 children in the home at any time, and ratio (age of the children) must be observed. The Licensee states that she does not transport children via vehicle and that she understands that children cannot be left in parked vehicles unattended at any time. Licensee uses redirection and communication with children as a form of discipline.
Department website: www.ccld.ca.gov provided to Licensee. LPA discussed the requirements of AB 633 whenever a Type A deficiency is cited. LPA also discussed "zero tolerance" related regulations with the Licensee. LPA advised Licensee on the "Mandated Reporter" training mandatory for licensees and all adults in contact with children. LPA referred the Licensee to the Department website: www.ccld.ca.gov and www.mandatedreporterca.com for additional information on the online training.
LPA advised licensee of the pending Department regulation update re: Safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.
There were not deficiencies cited during today's inspection. Licensee's rights form was printed and handed to Licensee both in English and Spanish. Licensee was provided a handout that reviews the ratio and capacity limitations for children accepted when Licensees have a Large Family Child Care Home license. LPA conducted an exit interview with licensee and advised her that a large FCCH license will be approved pending on the following: 1) Licensee will submit to Licensing Department (LD) proof not older than a year for not active Tuberculosis for both Esteban and Amada. 2) Licensee will submit signed forms LIC508 for the same adults. and 3) Approval from a manager of the Licensing Department.
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 Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

LIC809 (FAS) - (06/04)

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