430753625-2-28-2020-07-CC-MSMS-BM922J-20200228160048

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430753625
Report Date: 02/28/2020
Date Signed: 02/28/2020 04:00:54 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:	PESTANO, MARILYN		FACILITY NUMBER:	430753625
ADMINISTRATOR:	PESTANO, MARILYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 734-8806
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94089
CAPACITY:	12	CENSUS: 8	DATE:	02/28/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Marilyn Pestano		TIME COMPLETED:	04:10 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) Mel Matos arrived at the home today at 2:15 PM for a Required - 1 year annual inspection. LPA met with Marilyn Pestano, Licensee, and explained the nature of today's inspection to her. LPA also observed eight day care children (3 infants & 5 preschool), one adult assistant, and Licensee's spouse in the home during today's inspection. Days and hours of operation are Monday to Friday from 7:30 AM to 6:00 PM. The adults that reside in the home are the Licensee and her spouse. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill log was conducted on February 3, 2020. The Licensee and one adult assistant completed the required "Mandated Reporter Training for Child Care Workers" on January 22, 2020. The Licensee, Licensee's spouse, and adult assistant has the required immunization records. The Licensee's First Aid & CPR certifications are current and expire on October 20, 2021. LPA reviewed eight children's files (3 infant & 5 preschool) during today's inspection. The children's files were complete and including the following: current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A). LPA toured the indoor and outdoor areas of the home with the Licensee 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 side yard. 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 02/28/2020:

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020

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: PESTANO, MARILYN	FACILITY NUMBER: 430753625
	VISIT DATE: 02/28/2020

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 02/28/2020):

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. Any poisons are locked and inaccessible to the day care 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 February 20, 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 also reminded the 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.

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 Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020

LIC809 (FAS) - (06/04)

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