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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274416288
Report Date: 12/10/2020
Date Signed: 12/10/2020 10:08:25 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:VALENCIA, SUSANAFACILITY NUMBER:
274416288
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
12/10/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Susana ValenciaTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA), Joe Macias conducted an announced virtual platform/ Facetime Prelicensing Inspection. The LPA met with the Applicant Susana Valencia. The Applicant and her adult son Rafael Tapia are the only adults who reside in the home. The Applicant rents the home, and has provided a Property Owner/ Landlord Consent form/ LIC9149. Days and hours of operation are Monday thru Friday from 5am to 6pm. Applicant's certification for CPR and First Aid are current and expire May 2022. Applicant has current health preventative training. Applicant may obtain liability insurance upon receiving her license.

LPA toured the indoor and outdoor areas during today's visit via Facetime. Off limit areas are as follows: all bedrooms, family bathroom, and garage. LPA observed a fully charged 2A10BC fire extinguisher. LPA observed working smoke and carbon monoxide detectors. The LPA observed a securely gated fireplace in the home. There are no bodies of water. Applicant stated that there are no weapons or firearms in the home. Cleaning products, medications, sharp objects and other similar items are securely stored and inaccessible to children. LPA advised applicant that poisons need to be locked. LPA reminded applicant that baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes.

Applicant will be using positive communication, redirection, and modeling good behavior as forms of discipline. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Discussed 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. LPA informed applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

LPA advised the Licensee of the new immunization requirement (pertussis, measles, and flu vaccines) for all Licensees and staff that work directly with the children. LPA has received copies of the Applicant's immunization records.

Applicant has completed the Mandated Reporter Training.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2020
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: VALENCIA, SUSANA
FACILITY NUMBER: 274416288
VISIT DATE: 12/10/2020
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The LPA also reviewed the Child Care Program COVID-19 Self-Assessment check list with the Applicant.

LPA also went over safe sleep for infants:

· Always place infants on their backs for sleeping.


· Use a tight-fitting sheet on the crib or play yard mattress.
· Do not hang any items from the crib or above the crib.
· Keep all items out of the crib or play yard.
· Pacifiers may be used as long as they do not have items attached to them.
· Infants should not be swaddled or have any items covering them while sleeping.


A review of staff records on December 10, 2020 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 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. A $500 immediate civil penalty. An ongoing $100 per day per violation continues until the violation(s) is corrected.

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 (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

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 AB 2231: Civil Penalty Updates effective July 1, 2017 with Applicant. A $500 immediate civil penalty and $100 per day violation until corrected is assessed for serious violations "zero tolerance" such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury.

LPA conducted an exit interview with the Applicant via Facetime and advised that a small Family Child Care Home license will be issued pending management approval. A copy of this report was provided to the Applicant via email.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2020
LIC809 (FAS) - (06/04)
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