430756236-5-7-2019-07-CC-MSMS-BBXPBT-20190507111052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430756236
Report Date: 05/07/2019
Date Signed: 05/07/2019 11:10:57 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:	ROSS, VANESSA		FACILITY NUMBER:	430756236
ADMINISTRATOR:	ROSS, VANESSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 732-3088
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY:	14	CENSUS: 11	DATE:	05/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Vanessa Ross		TIME COMPLETED:	11:20 AM

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 met with Vanessa Ross, Licensee, for an unannounced annual/random inspection. LPA also observed two adult assistants, Licensee's adult daughter, and eleven preschool children in the home during today's inspection. Days and hours of operation are Monday - Friday from 6:30 AM to 6:00 PM. The Licensee, Licensee's spouse, and the Licensee's adult daughter are the adults residing in the home. Licensee's certifications for CPR and First Aid are current and expire in February 2021. Licensee's two adult assistants and her adult daughter's CPR and First Aid certifications are current and expire in February 2021. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on April 15, 2019. The Licensee has day care insurance through DCI Insurance. LPA reviewed eleven 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 reviewed two complete staff files during today's inspection. The Licensee, two adult assistants, and Licensee's adult daughter has completed the Mandated Reporter Training for Child Care Workers and have the required immunization records on 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. LPA did not observe any wall heaters inside the home. Off limit areas in the home: three bedrooms, one bathroom, one barricaded fireplace (located in the living room), and attached garage. There are no stairs inside the home. Off limit areas outside the home: entire backyard. The Licensee has the front yard fenced off and uses that area as the playground for the children. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 05/07/2019):

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019

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: ROSS, VANESSA	FACILITY NUMBER: 430756236
	VISIT DATE: 05/07/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 05/07/2019):

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee states that she does not have any weapons in the home. The Licensee has a Pit/Labrador mix dog and cat that is vaccinated and kept in off limit areas during day care hours. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.

A review of staff records on May 2, 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 with a qualified assistant present. The Licensee states that she does transport children and understands that children shall not be left unattended in a vehicle.

No deficiencies issued during today's inspection.

LPA conducted an exit interview with the Licensee and advised her of the pending Department regulation update re: safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

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

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019

LIC809 (FAS) - (06/04)

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