430757671-12-4-2024-07-CC-JBER-DBMU9C-20241204142255

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430757671
Report Date: 12/04/2024
Date Signed: 12/04/2024 02:23:03 PM

Document Has Been Signed on 12/04/2024 02:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	SILVESTRE, ADELMAR & CLEM		FACILITY NUMBER:	430757671
ADMINISTRATOR/ DIRECTOR:	SILVESTRE, ADELMAR & CLEM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 267-2422
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	12/04/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Adelmar Silvestre		TIME VISIT/ INSPECTION COMPLETED:	02:35 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), Jennifer “Jen” Beehler, met with Licensee, Adelmar Silvestre, for an unannounced Required- 1 Year Inspection. LPA was granted access to the home by the Licensee and toured both indoors and outdoors during the inspection. Upon arrival, there were 7 children ( 5 - preschool aged 2 - infant aged), 2 staff (Licensee and Assistant) and spouse (Clem) present, which is compliant with the home license capacity and ratio requirements. LPA observed all required postings near the entrance to the home. Hours of operation for the facility are Monday – Friday, 06:00AM-06:00PM. Licensee states that adults, over the age of 18, residing in the home are: herself, her spouse (Clem), and her sister (Evedina). All adults residing in the home have Criminal Background Check Clearance and signed Criminal Record Statements (LIC508). Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. LPA reviewed facility roster (LIC9040) and fire/disaster drill log during today's inspection. The last fire/disaster drill was conducted on 06/14/2024, which is compliant with the six month requirement for homes. LPA observed a fully charged 2A10BC fire extinguisher that was last serviced 10/18/2024 which is compliant with fire marshal requirement. A fully functioning smoke detector and carbon monoxide detector were present. Licensee states that she does not currently have any children in care who require Incidental Medical Services but does administer medication as needed for children in care. Continued on Page 2

Joel Segura
Jennifer Beehler
	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SILVESTRE, ADELMAR & CLEM	FACILITY NUMBER: 430757671
	VISIT DATE: 12/04/2024

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Indoor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Licensee states that there are no weapons or firearms in the home. Off-limits areas of the home (indoors): 4 bedrooms, one bathroom, living room, laundry room and kitchen. Licensee has a fireplace in the living room which is off limits from children in care. There are stairs between the kitchen and laundry room. This is also in the off limits area of the day care. Provider showed LPA how there is a barricade using a moveable short wall to block off the laundry room and stairs from children in care. LPA observed sufficient age-appropriate materials, toys, and play equipment in the home. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. Drinking water is readily available for children in the facility via water dispensers and disposable cups. When the children are outside, they will bring a pitcher and cups with them. The day care bathroom in the home is clean, sanitary, and operable. The Licensee used a land line as a working telephone, the number is 408-267-2422.

The backyard area of the home was inspected. LPA observed sufficient play equipment and supplies for the children that are in good condition and age-appropriate. Off-limit areas outside of home include: both side yard areas and the front yard. No outdoor bodies of water were observed during today's inspection.

Infant Safe Sleep regulations (PIN 20-24-CCP) were discussed with the Licensee, including the Individual Infant Sleeping Plan (LIC9227). LPA reminded Licensee that infants up to 12 months of age should be placed on their back to sleep, that cribs should be free of all loose articles and hanging objects, and that infants should not be swaddled. Infants should be supervised while sleeping and documentation of sleep checks every 15 minutes should remain in the infant’s file. LPA observed an up to date sleeping log for both infants in care and up to date infant sleep plans in their files signed by parents and provider.

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SUPERVISOR'S NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SILVESTRE, ADELMAR & CLEM	FACILITY NUMBER: 430757671
	VISIT DATE: 12/04/2024

NARRATIVE

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LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

3 children’s files were reviewed during today's inspection and all required documents were present, including Individual Infant Sleep Plan (LIC9227) and sleep check documentation for all infants. Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700, Immunization Records (PM286). All files were complete.

Licensee provided proof of liability insurance that is active from 02/28/2024-02/28/2025.

1 staff file (Assistant) was reviewed. Employee Rights (LIC9052), Criminal Record Statement (LIC508), Statement Acknowledging Requirement to report Child Abuse (LIC9108), Mandated Reporter Training Certificate, and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza were all present. Licensees and staff person all have current CPR/First-Aid that expires 08/03/2026. Licensees and assistant have completed mandated reporter which expires in July of 2026 for all parties. LPA reminded licensee that training must be renewed by all staff every 2 years.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The Licensee states that she does not transport any day care children. LPA reminded Licensee that children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

As a result of today's inspection no deficiency was cited. Exit interview conducted. Report reviewed and provided to licensee, Adelmar Silvestre. NOTICE OF SITE VISIT WAS PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISOR'S NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

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