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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430756525
Report Date: 08/19/2021
Date Signed: 08/19/2021 02:48:58 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:GARCIA, BAUDELIA & GUADALUPEFACILITY NUMBER:
430756525
ADMINISTRATOR:GARCIA, BAUDELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 224-1933
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY:14CENSUS: 6DATE:
08/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Baudelia and Guadalupe GarciaTIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Janette Cruz met with Baudelia Garcia and Guadalupe Garcia, Licensees, for an unannounced Required – 1 year annual inspection. LPA was granted access to the home by the Licensees. LPA also observed six children (2 infant, 4 preschool) in the home during today's inspection. The Licensees were operating within their capacity and ratio requirements during today's inspection. LPA observed the required postings, including the facility license, near the front entrance to the home. The home has a working telephone (408) 224-1933. Days and hours of operation are Monday - Fridays from 7:00AM to 5:30 PM. The Licensees are the adults residing in the home. The Licensees' CPR and First Aid on file expire on 12/19/2022.

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 08/10/21. The Licensees have the required vaccinations (MMR, Tdap, & flu). The Licensees' Mandated Reporter Training for Child Care Workers on file expire on 01/22/23 (Guadalupe) 12/18/2022 (Baudelia). LPA reviewed six children's files and observed current and updated Identification and Emergency Information (LIC 700) and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. The Licensees state that a child will be isolated in the front living room area if needed to because of illness or communicable disease.

LPA discussed the new “Safe Sleep” regulations with the Licensees and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensees.

REPORT CONTINUED ON FOLLOWING PAGE #2 - REPORT DATED 08/19/2021):
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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: GARCIA, BAUDELIA & GUADALUPE
FACILITY NUMBER: 430756525
VISIT DATE: 08/19/2021
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LPA reminded the Licensees that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly with heating and ventilation for safety and comfort of children. LPA observed a glass door covered fireplace unit in the home. Off limit areas inside the home: front living room, 1 bedroom/office, 1 bathroom inside master's bedroom and attached garage. Off limit areas outside the home: left and right side of the backyard. LPA observed a play yard gate surrounding the backyard. LPA advised Licensee to update facility sketch of indoor and outdoor areas of the home. LPA observed no bodies of water.

LPA observed a fully charged 3A40BC fire extinguisher and working smoke/carbon monoxide detectors. LPA observed the Licensees have 2 birds (cockatoo and dove) kept at the right side of the backyard away from children. Licensees state that there are no weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. LPA observed any poisons are locked in high cabinets at the kitchen inaccessible to the day care children. Licensees have liability insurance coverage up to 9/29/2021.

A review of staff records on 08/19/21 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 Licensees 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.
REPORT CONTINUED ON FOLLOWING PAGE #3 - REPORT DATED 08/19/2021):
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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: GARCIA, BAUDELIA & GUADALUPE
FACILITY NUMBER: 430756525
VISIT DATE: 08/19/2021
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Supervision of children was discussed with the Licensees and they understand that they must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensees understand their capacity options and understand that they cannot have more than 14 children in the home at any time without a fully qualified adult present. The Licensees state that they do not transport any day care children. The Licensees understand that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

LPA conducted an exit interview with the Licensees and they agreed to have the following item/s submitted to LPA Cruz by Thursday, 08/26/21.
1. Copy of updated facility sketch showing changes on off-limit areas inside and outside of the home.


No deficiencies issued during today's inspection.


A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC809 (FAS) - (06/04)
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