430757125-2-11-2020-07-CC-FCJO-BLPT23-20200211132006

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430757125
Report Date: 02/11/2020
Date Signed: 02/11/2020 01:20:15 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:	CRUZ, GUADALUPE		FACILITY NUMBER:	430757125
ADMINISTRATOR:	CRUZ, GUADALUPE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 225-2941
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95121
CAPACITY:	14	CENSUS: 4	DATE:	02/11/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Sarai Cruz		TIME COMPLETED:	01:30 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) Fermin Campos-Jaramillo conducted an unannounced annual inspection to the home today. LPA met with Sarai Cruz, Licensee's daughter and helper, and explained the nature of today's inspection to her. Licensee arrived at 12:40 PM. LPA observed there were four children present today included one infant and three preschool age children. Days and hours of operation are Monday to Friday from 5:00 AM to 6:00 PM The adults that reside in the home are the Licensee and her husband Beltran. Licensee's certifications for CPR and First Aid are current and will expire on 6/29/2020 and for helper Sarai on 8/20/2020. LPA toured the indoor areas of the home during today's visit. The Licensee has a working telephone in the home. Licensee has documented a fire drill on 1/17/2019. LPA obtained a copy of the current children roster today. LPA observed sufficient materials, toys, and play equipment for the day care children. LPA did not observe any wall heaters inside the home. Off limit areas in the home are bedroom #1, master bathroom, and the attached garage. There are not stairs inside the home. Off limit areas outside the home is the back yard. Licensee's helper stated they are not currently using the back yard for day care. LPA observed a fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detectors, and no bodies of water. Sarai states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. Licensee has proof of immunization for pertussis, measles, and influenza in file as required by the SB792. Licensee's helper does not have available proof of immunization for measles, pertussis, and influenza. A review of staff records on 2/06/2020 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. *************************************Report dated 2/11/2020 continues in page 2.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020

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: CRUZ, GUADALUPE	FACILITY NUMBER: 430757125
	VISIT DATE: 02/11/2020

NARRATIVE

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Report dated 2/11/2020 continues from page 1.

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 care in the home, and ratio (age of the children) must be observed. Licensee's helper states that Licensee transports children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.

Department website: www.ccld.ca.gov provided to Licensee.
LPA discussed the requirements of AB 633 with the Licensee. LPA also discussed "zero tolerance" related regulations with the Licensee.

Licensee and her helper have completed the "mandated reporter" training on 7/6/2020. Licensee understands the training is mandatory to all Licensees and adults in the home in contact will children and is required to be completed starting January 1, 2018. LPA referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training.
LPA advised licensee 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. LPA advised licensee to sign up with the Child Care Advocate program.
Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.
Exit interview conducted with Licensee.
Type B deficiencies were cited during today's inspection.
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: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020

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: CRUZ, GUADALUPE	FACILITY NUMBER: 430757125
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/11/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/25/2020 Section Cited	1 2 3 4 5 6 7	(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
	8 9 10 11 12 13 14	This regulation was not met as evidenced by: Licensee's helper Sarai was unable to present proof of immunization for measles, pertussis, and influenza. This poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
Type B 02/25/2020 Section Cited	1 2 3 4 5 6 7	(A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.1. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
	8 9 10 11 12 13 14	This regulation was not met as evidenced by: Licensee has not documented a fire drill since January 17, 2019 Licensee understands this poses a potential risk to the children in care.	8 9 10 11 12 13 14

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 Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020

LIC809 (FAS) - (06/04)

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