434404137-7-18-2019-07-CC-SCOS-BE7PWK-20190718114052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404137
Report Date: 07/18/2019
Date Signed: 07/18/2019 11:41:03 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:	OCHOA-CHACON, ANA		FACILITY NUMBER:	434404137
ADMINISTRATOR:	ANA OCHOA-CHACON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	4082544601
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY:	14	CENSUS: 6	DATE:	07/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Ana Ochoa-chacon		TIME COMPLETED:	11:45 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	On July 18, 2019 Licensing Program Analysts (LPAs) Stephanie Collins Tuoc Doan conducted an annual inspection of Family Child Care Home of licensee Ana Ochoa-Chacon. LPAs met with Licensee Ana Ochoa-Chacon and explained the purpose of today's inspection. Present in the home were #6 children of whom 1 was infant age, and Licensee’s assistant Claudia De La Torre. Days and hours of operation are Monday through Friday from 7:30 AM –5:00 PM. Licensee understands the capacity options and understands that the maximum capacity is 14 children. There are two (3) adults residing in the home; Licensee, and Licensee’s Husband (Miguel Carranza) and son Miguel Gonzalez. Adults in the home have Clearances for Criminal Background and Child Abuse Index Background Checks, and Tuberculosis. A review of staff records on (07/01/2019 shows that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA 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. Licensee's Pediatric CPR and First Aid expires on 06/2021. LPAs observed both Licensee and assistant has proof of immunity against Measles and Pertussis. Licensee's AB1207 Mandated Reporter Training Certificate expires 11/02/2019. LPAs reviewed the roster of children in care and a copy was obtained.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

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: OCHOA-CHACON, ANA	FACILITY NUMBER: 434404137
	VISIT DATE: 07/18/2019

NARRATIVE

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LPAs reviewed (#6) children's files. Records review include Parents' Rights, Emergency Contact Information, Consent for Emergency Medical Treatment form, and immunization.

Licensee stated she does not transport children and that there are no weapons, such as firearms stored on the premises.

LPAs inspected the indoor and outdoor areas of the home today. Smoke and Carbon de monoxide detectors were tested and proved to be functioning. LPAs observed a fully charged ABC 4A:60 BC fire extinguisher. Fire and disaster drills were last conducted and recorded on 05/20/19. Off limits area in the home are all three Bedrooms, Master Bathroom, and Garage. LPA’s observed a fully fenced back yard that is used for outdoor activities. No bodies of water were observed

Medication, cleaning products and similar items that can pose a danger to children if readily accessible are stored inaccessible to children.

Licensee states that currently she is not providing Incidental Medical Services. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. .

Beginning January 1, 2019 AB2370 requires licensed homes and centers 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 facility. Safe sleep information was reviewed with Licensee.

LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

No regulatory violations were observed during the inspection visit. Exit Interview was conducted, where this report was discussed and reviewed with Licensee. A copy of this report was given to Licensee.

NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

LIC809 (FAS) - (06/04)

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