274415900-11-26-2019-07-CC-EBEN-BJAP6P-20191126100237

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274415900
Report Date: 11/25/2019
Date Signed: 11/26/2019 10:03:41 AM

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, WENDY		FACILITY NUMBER:	274415900
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	11/25/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Wendy Garcia		TIME COMPLETED:	03:45 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) Elizabeth Berumen conducted a pre licensing inspection. LPA met with Applicant, Wendy Garcia and explained the nature of today's inspection. The day care hours of operation will be 3:00 AM to 8:00 PM. There are two adults living in the home; Applicant and her husband, Jose De Jesus Centeno. Applicant has 4 children ages; 17, 15, 11, 4 years old. She understands that once her daughter turns 18 she is to be fingerprinted. LPA discussed with Applicant Wendy Garcia 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 The applicant has current CPR and First Aid which expires on 02/02/2021. LPA Berumen reviewed Applicant's immunization's against measles, pertussis and influenza. LPA discussed rosters need to be current, fire disaster/earthquake drills need to be done and logged at least every six months. Applicant does not have day care insurance and will use the affidavit regarding liability insurance. Applicant's husband owns the home and Applicant has consent to use the home as a family child care home. LPA Berumen inspected the indoor and outdoor areas of the home. Off limit areas inside the home are: 3 bedrooms and garage. The off limit outdoor areas are locked storage shed and portion of the backyard. Applicant is only using the fenced (enclosed) area for day care children. The trampoline in the backyard is not for day care children use.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2019

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: GARCIA, WENDY	FACILITY NUMBER: 274415900
	VISIT DATE: 11/25/2019

NARRATIVE

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LPA Berumen observed that the home is equipped with a working smoke/carbon monoxide detector and 3A40BC fire extinguisher. Applicant has a working cell phone in home. No bodies of water were observed. Wendy states that there are no weapons in the home. Cleaning products, toxic agents, medications, and sharp objects are inaccessible to children. LPA reminded Applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes.
Forms of discipline used by Applicant will be redirection and talking to children. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed.

LPA discussed the requirements of AB 633 with Applicant and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA also discussed "zero tolerance" related regulations with the Applicant and advised her of the assessment of an immediate $500 civil penalty, and an ongoing $100 per day per violation continues until the violation(s) is corrected. SB 792 Immunization Requirements was discussed. Incidental Medical Services (IMS) policy was discussed. 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.
LPA obtained a copy of control of property.
LPA conducted an exit interview with the Applicant and advised her that a small Family Child Care Home license will not be approved until the following is completed:
1. The home shall be equipped with safe toys, play equipment and materials. The home is not set up for day care.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2019

LIC809 (FAS) - (06/04)

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