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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430756122
Report Date: 02/21/2020
Date Signed: 02/21/2020 10:56:13 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:IGLESIAS, PATRICIAFACILITY NUMBER:
430756122
ADMINISTRATOR:IGLESIAS, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 848-6520
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 4DATE:
02/21/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Patricia IglesiasTIME COMPLETED:
11:05 AM
NARRATIVE
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LPA Deanna Villagrana met with licensee Patricia Iglesias for an unannounced 1 year required visit. LPA explained the nature of today’s inspection to her. Present were licensee, licensee's assistant, and four day care children. Days and hours of operation are Monday to Friday, 6:00am to 6:00pm. The adults that reside in the home are licensee, her husband, with their 16 year old daughter and 13 year old son.

A review of staff records on 02/18/2020 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensee shall immediately remove the individual and prevents them from returning to the home or having contact with children in care.

LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed a barricaded fireplace in the home. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. LPA observed Clorox wipes accessible to children in the day care room. LPA observed dog poop in the play area of the back yard. LPA observed a fully charged 3A40BC fire extinguisher. LPA observed a working smoke detector and a working carbon monoxide detector. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: three bedrooms. There are no bodies of water. Backyard is fenced. Off limits outdoor: left side of home that is fenced off to children. LPA observed a storage was unlocked with items such as a weed eater and lawn mower accessible to children. LPA observed one pet dog in the home. Licensee states is vaccinated.

LPA observed licensee and her assistant have current CPR and First Aid certification expiring 01/02/2022. LPA discussed SB792 Immunization Requirements and observed licensee and her assistant's have immunization against pertussis, measles and influneza on file.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
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 3
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: 02/21/2020
NARRATIVE
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LPA observed a current roster of the children and a fire and disaster drill log which was last completed on 12/16/2019. LPA reviewed four children's files and observed all forms are completed and children have current immunization records. Licensee states day care is insured with DCI. LPA observed insurance expires 06/26/2020.

Supervision of children was discussed with 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. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time. Licensee understands if she transports children via vehicle, children cannot be left in parked vehicles unattended at any time.

LPA discussed Zero Tolerance with $500 immediate civil penalty. An ongoing $100 per day per violation continues until the violation(s) is corrected. LPA discussed the requirements of AB633 to licensee and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and licensee understands the requirements. Incidental Medical Services were discussed with the licensee. The licensee is not providing IMS (Incidental Medical Services) at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

LPA reminded the Licensee that effective January 1, 2019 Assembly Bill 2370 requires that all licensed homes to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the Licensee. LPA advised the Applicant of the pending Department regulation update regarding safe sleep for infant children. LPA referred the Applicant to the Department website: www.ccld.ca.gov for additional information and provided licensee with a "Safe Sleep" handout.

The following type A deficiencies were cited on the attached page (809-D). Appeal rights were provided to the Licensees prior to the conclusion of today's inspection.

Notice of site visit was issued and must be posted for 30 days.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2020
Section Cited

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102417(b) Operation of a Family Child Care Home. The home shall be kept clean and
orderly, with heating and ventilation for safety and comfort. This requirement was not met as evidenced by LPA observed dog poop in the play area of the back yard.
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This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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Type A
02/21/2020
Section Cited

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102417(g)(4) Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children.
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This requirement was not met as evidenced by LPA observed Clorox wipes accessible to children in the day care room. LPA observed a storage was unlocked with items such as a weed eater accessible to children. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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AB633 Parent Notification is required.
This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2020
LIC809 (FAS) - (06/04)
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