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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430753625
Report Date: 07/11/2019
Date Signed: 07/11/2019 10:32:16 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:PESTANO, MARILYNFACILITY NUMBER:
430753625
ADMINISTRATOR:PESTANO, MARILYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 734-8806
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY:12CENSUS: 8DATE:
07/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Marilyn PestanoTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Mel Matos met with Marilyn Pestano, Licensee, for an unannounced random/annual inspection. LPA also observed eight day care children (4 infants & 4 preschool) and Licensee's spouse (Anicleto "Clay") in the home during today's inspection. Days and hours of operation are Monday to Friday from 6 AM to 6 PM. The adults that reside in the home are the Licensee and her spouse. CPR & First Aid certifications for the Licensee, Licensee's spouse, and Licensee's assistant are current and expire in October 2020.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Last fire/disaster drill log was conducted on July 8, 2019. The Licensee, Licensee's spouse, and one adult assistant completed the required "Mandated Reporter Training for Child Care Workers" on January 8, 2018. The Licensee, Licensee's spouse, and adult assistant has the required immunization records. LPA reviewed eight children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file.

LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. Off limit areas in the home: two bedrooms, living room, attached garage, and one bathroom. There are no stairs and no wall heaters inside the home. Off limit areas outside the home: gated left & right side yards. LPA observed a play structure in the backyard that is secure and safe for the children. LPA also observed resilient soft rubber surfacing (Play N Pour) under and around the play structure during today's inspection.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 07/11/2019:
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: PESTANO, MARILYN
FACILITY NUMBER: 430753625
VISIT DATE: 07/11/2019
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 07/11/2019):

LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. The Licensee states that she does not have any weapons in the home. The Licensee states that she does not administer any medication to the day care children.

A review of staff records on July 9, 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 capacity options and she understands that she cannot have more than 14 children in the home at any time. Licensee also understands that she must comply with the ratio and capacity requirements of the small Family Child Care Home License whenever she is alone with the day care children. The Licensee states that she does not transport child care children.

LPA conducted an exit interview with the Licensee and advised her that no deficiencies issued as a result of today's inspection.

The Licensee agreed to submit an updated Application for a Family Child Care Home License (LIC 279) and Emergency Disaster Plan (LIC 610A) by Friday July 19, 2019.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2