274415895-2-27-2020-07-CC-DVIA-BM7TV6-20200227140325

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274415895
Report Date: 02/27/2020
Date Signed: 02/27/2020 02:03:31 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:	MARTINEZ, JOSE & AYALA, VIRIDIANA		FACILITY NUMBER:	274415895
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	02/27/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Viridiana Ayala		TIME COMPLETED:	02:10 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) Deanna Villagrana conducted an unannounced case management inspection in response to Licensees’ request to increase the capacity of her Family Child Care Home (FCCH) from 8 to 14 children. Present were licensee Viridiana Ayala and two day care children. LPA inspected the entire indoor and outdoor area of the home. The home is equipped with a 3A40BC fire extinguisher, carbon monoxide and smoke detector. LPA observed a barricaded wall heater. Days and hours of operation will be Monday to Saturday 6:00 am to 6:00 PM. CPR and First Aid certification is current and expires 04/12/2020. Licensee rents the home and has consent from landlord signed on 05/22/2018. LPA observed day care is insured with DCI and expires in May 2020. A Fire Clearance was granted on 02/21/2020. LPA notes that a pre licensing inspection was conducted on 01/10/2019 for a small family child care home. Off limit areas in the home are 3 bedrooms, hallway closet and attached garage. The garage is converted into a studio and landlord's daughter and her children live in it. Licensee will use the front yard for outdoor play. A section of the front yard is barricaded and licensee understands children must be supervised at all times. Licensee states she will not be using the backyard for day care. Licensee has three dogs in the backyard area. Cleaning products, medication, and similar items are stored inaccessible to children. LPA discussed capacity options of a Large Family Child Care Home License. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home shall be either: (1) 12 children, no more than four of whom may be infants; or (2) more than 12 and up to 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age and there are no more than three infants being cared for during any time when more than 12 children are being cared for.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

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: MARTINEZ, JOSE & AYALA, VIRIDIANA	FACILITY NUMBER: 274415895
	VISIT DATE: 02/27/2020

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When Licensee has more than 12 and up to 14 children in the home, Licensee must notify the parent using the form LIC9150 “Parent Notification Additional Children in Care." LPA reminded Licensee that when Licensee does not have a Helper, Licensee can only care for up to 8 children at any one time in the home.

Adults living in the home are Licensees, licensee's adult daughter and 15 year old son. Licensee Viridiana states her in laws stay in the home but are in Mexico a couple of months throughout the year. All adults including tenants in attached studio have Criminal Record, Child Abuse Index, and TB Clearance. LPA 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.

An exit interview was conducted and a copy of this report was left with licensee Viridiana, whose signature on this form confirm receipt of these documents.

No deficiencies were cited during visit

Licensee was informed that upon receipt of Licensing Management's approval, a license for a Large Family Child Care Home will be granted and issued to Licensee.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

LIC809 (FAS) - (06/04)

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