434404432-8-1-2019-07-CC-AALZ-BEMTUT-20190801150251

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404432
Report Date: 08/01/2019
Date Signed: 08/01/2019 03:02:57 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:	LEON, MELANIE		FACILITY NUMBER:	434404432
ADMINISTRATOR:	LEON, MELANIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 422-8893
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	14	CENSUS: 9	DATE:	08/01/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Leon, Melanie		TIME COMPLETED:	03:00 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) Araceli Almaraz conducted an annual random inspection. LPA met with Licensee, Leon, Melanie and explained the nature of today's inspection. Present during the inspection was the licensee and son/assistant Leon, MarcAnthony. There were nine children present including one infant. The hours of operation of the day-care are 6 AM to 6 PM, Monday through Friday. There are three adults residing in the home: Licensee, spouse Leon, Pedro and son/assistant. Licensee and assistant have CPR and First Aid, which has an expiration date of 04/2020. LPA reviewed nine 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 observed that the Licensee and assistant have record of MMR & Tdap vaccinations as well as the opt out form for the flu vaccine. LPA observed a working smoke/carbon monoxide detector, 3A40BC fire extinguisher and no bodies of water were observed. LPA did not observe any heaters in the home. LPA observed a barricaded fireplace. LPA inspected the indoor and outdoor areas of the home today. Off limit areas in the home are as follows: Master bedroom, master bathroom and bedroom three. Off limit areas outside the home are as follows: The right side of the back yard, is made inaccessible with a gate. The front yard is safety compliant and backyard is fully fenced. Medication, cleaning products and similar items are stored inaccessible to children. Poisons shall be locked. LPA observed a current roster, a current fire disaster/earthquake drills last log 06/03/2019. Licensee states that there are no weapons in the home. Licensee has no pets. Licensee has no day care insurance. Licensee completed Mandated Reporter Training on 04/2018, licensee understands training is to be completed every two years. PG 1/3

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

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: LEON, MELANIE	FACILITY NUMBER: 434404432
	VISIT DATE: 08/01/2019

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. 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

Supervision of the children was discussed; the Licensee understands a cleared adult must be present in the home during day care hours. Licensee understand that the children must be supervised at all times. The Licensee understands the capacity options and ratio requirements Licensee understands not to leave children in the car unattended. The Licensee states that there is no transporting of children currently

A review of staff records on 07/01/2019 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 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.

PG 2/3

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019

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: LEON, MELANIE	FACILITY NUMBER: 434404432
	VISIT DATE: 08/01/2019

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

There are no deficiencies during today’s inspection.

LPA conducted an exit interview with the Licensee and advised the 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 discussed the requirements of AB633 to Licensee.

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

PG 3/3

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019

LIC809 (FAS) - (06/04)

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