430756122-12-11-2019-07-CC-SYIP-BJS294-20191211161120

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430756122
Report Date: 12/11/2019
Date Signed: 12/11/2019 04:11:25 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:	IGLESIAS, PATRICIA		FACILITY NUMBER:	430756122
ADMINISTRATOR:	IGLESIAS, PATRICIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 848-6520
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 7	DATE:	12/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:28 PM
MET WITH:	Rocio Juarez- Arredondo and Patricia Iglesias		TIME COMPLETED:	04:15 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) Samantha Yip conducted an unannounced annual random inspection. LPA met with Rocio Juarez- Arrendondo, Assistant, and explained the reason for the inspection. Present during the inspection were 7 children, whom one was infant age. Licensee arrived at 3:35PM. License and Notification of Parent's Rights were observed to posted. The hours of operation are Monday through Friday 5AM to 530PM. LPA toured in the inside and outside of the home with Assistant. The off-limit area are all three bedrooms, the left side of the backyard, and the two sheds in the backyard. LPA reminded Licensee to ensure that all sheds are locked. There are no stairs in the home. All disinfectants, cleaning supplies, and other items that are dangerous to children were observed to stored inaccessible. LPA reminded Licensee that cleaning supplies, such as Clorax wipes and Magic Erasers, should be stored inaccessible to children. LPA observed that there is sufficient amount of toys for children in care. There were no baby walkers observed during today's inspection. Furniture and equipment, such as tables, chairs, napping mats, and high chairs, were age appropriate. LPA observed that blue chairs in daycare area are starting to crack. Licensee stated that she will put tape over the cracks. LPA observed a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire drill was conducted on 11/2019. Assistant stated that there are no weapons, such as firearms, stored in the home. The backyard is used and is fenced. LPA observed that there are sufficient amount of toys and equipment for children in care. LPA reminded Licensee to dump any water that collect before children's use. Licensee has a waiver to have a trampoline in the backyard. ----------------------continues on 809 dated 12/11/2019 page 2-------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

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: IGLESIAS, PATRICIA	FACILITY NUMBER: 430756122
	VISIT DATE: 12/11/2019

NARRATIVE

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----------------------continuation of 809 dated 12/11/2019 page 1------------------------------
Licensee does transport children at this time and understands that children cannot be left alone and unattended in parked vehicles.

A copy of the facility roster was obtained. LPA reminded Licensee to update the facility roster as needed. 6 children's files were reviewed during today's inspection. The records reviewed include but not limited to consent for emergency medical treatment and parent's rights.

Licensee and her Assistant have a valid CPR/1st Aid, which expires on 01/02/2020. Licensee and her Assistant's immunization records for pertussis and measles are on file. LPA reminded Licensee that the Mandated Reporter Training needs to be renewed every two (2) years.

The adults living in the home are Licensee and her spouse. All adults living in the home have cleared criminal record, child abuse index, and TB test results. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, 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.

Licensee stated that she currently does not have any children in care who requires IMS services. Incidental Medical Services (IMS) policy was discussed. 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 reviewed Safe Sleep information with Licensee. LPA also provided Licensee with Lead Exposure. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

In areas that were evaluated, no deficiencies have been cited. An exit interview was conducted, where this report was discussed and provided to Licensee. A NOTICE OF SITE VISIT WAS ISSUE AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

LIC809 (FAS) - (06/04)

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