274415924-5-13-2020-07-CC-SCES-BPKSBS-20200513134424

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274415924
Report Date: 05/11/2020
Date Signed: 05/13/2020 01:44:30 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:	JIMENEZ MARTINEZ, MARIA		FACILITY NUMBER:	274415924
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	05/11/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Maria Jimenez Martinez		TIME COMPLETED:	02:08 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	On 5/11/2020 at 12:30 PM, Licensing Program Analyst (LPA) Susy Cervantes, met with applicant, Maria Jimenez Martinez to conduct a pre-licensing tele-visit in this facility. Tele-visit was conducted due to Covid-19. Applicant was present with her children ages 2, 8, and 11. The adults that reside in the home are the Applicant and her husband Francisco. Days and hours of operation will be Monday - Saturday from 4:00 AM to 2:00 AM. Applicant has completed her Preventative Health and Safety Child Care Training and is on file. Applicant's CPR and First Aid certifications are current and expire on 8/3/21. Applicant and husband are owners of the home. Applicant does not have liability insurance and will issue affidavit regarding liability insurance for FCCH. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 5/8/2020 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPA reminded Applicant 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. LPA toured the indoor and outdoor areas during today's inspection. There are no stairs in the home. Off limit areas inside the home: kitchen, master bedroom, and one bedroom. LPA observed a fully charged 3A40BC fire extinguisher, working smoke detector and carbon monoxide detector, fenced backyard, and no bodies of water. Off limit areas outside the home: children outdoor play area is on the right side yard, back yard is fenced off and off limits, applicant's dog resides in the off limits are, applicant stated dog is vaccinated. *Continues on report dated 05/11/2020*

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2020

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: JIMENEZ MARTINEZ, MARIA	FACILITY NUMBER: 274415924
	VISIT DATE: 05/11/2020

NARRATIVE

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Continuation of report dated 05/11/2020
Applicant states that there are no weapons in the home. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children and stored in the top cabinets in the kitchen. LPA reminded Applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes.

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 unusual incidents/injuries, suspected child abuse (Mandated Reporter training AB 1207), SB 792 (Immunization's for Measles Pertussis and Influenza) and healthy beverages in child care, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

Incident 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) 415-0301 (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.

A Family Child Care Home packet with updated Licensing forms was emailed and reviewed with the Applicant. Department website: www. ccld.ca.gov provided to Applicant. LPA discussed the requirements of AB 633 with the Applicant and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Applicant understands the requirements. 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.

LPA informed Licensee that her report will be emailed to her. In lieu of a signature, a read receipt or confirmation of receiving the report email must be submitted within 24 hours. LPA conducted an exit interview with the Applicant in Spanish and advised that a license for a small family child care home will be approved pending the following:
1. Copy of certificate for Mandated Reporter Training (General only due to language availability)
2. Manager's Approval

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2020

LIC809 (FAS) - (06/04)

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