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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404552
Report Date: 12/19/2019
Date Signed: 12/19/2019 04:19:52 PM

COMPREHENSIVE INSPECTION
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:ALVAREZ, GLORIAFACILITY NUMBER:
434404552
ADMINISTRATOR:ALVAREZ, GLORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 729-4718
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:14CENSUS: 5DATE:
12/19/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Gloria AlvarezTIME COMPLETED:
04:30 PM
NARRATIVE
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LPA Deanna Villagrana met with licensee's son Ramon Rocha and licensee's assistant Maria Guadalupe Rodriguez for an unannounced annual/required inspection. LPA explained the nature of today’s inspection. Son stated mother Gloria Alvarez was picking up children and would be home shortly. Present were licensee's son, assistant and four day care children. Gloria arrived 10 minutes later with another day care child. Three additional children arrived several minutes later. Days and hours of operation are Monday to Friday, 6:00am to 6:00pm. The adults that reside in the home are licensee, her son with her 17-year-old granddaughter.

A review of staff records on 12/12/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensee shall immediately remove the individual and prevents them from returning to the home or having contact with children in care.

LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPA observed two barricaded wall heaters in the home. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. LPA observed diaper rash ointment, air fresheners and body sprays accessible to children in the day care room. LPA observed a fully charged 2A10BC fire extinguisher. LPA observed a working smoke detector. LPA observed a carbon monoxide detector in the living room that was not working. Licensee stated sometimes it gets unplugged and plugged it back in. It began to work after. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: Master bedroom/bath, three bedrooms, one bathroom and second living room. There are no bodies of water. Backyard is fenced. Off limits outdoor: entire backyard. Licensee uses front yard for outdoor play. Front yard is fenced and is closed while children play. Licensee states she has two dog that stay on the side of the house and have vaccinations. LPA observed several birdcages in the front yard of the home.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 8
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: ALVAREZ, GLORIA
FACILITY NUMBER: 434404552
VISIT DATE: 12/19/2019
NARRATIVE
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LPA observed licensee and her assistant have current CPR and First Aid certification. Licensee’s expires 08/14/2020 and assistant's 12/01/2020. LPA did not observe a current roster of the children. LPA observed a fire and disaster drill log which was last completed 10/17/2018. LPA observed licensee filled in dates 04/20/2019 and 10/16/2019. LPA reviewed seven children's files and observed all forms are completed and children have current immunization records. Child 7 is missing LIC700. Child 7 is missing LIC995A. Child 7 is missing LIC9224. Child 7 is missing immunizations. Child 7 is missing LIC 627. Licensee states day care is not insured. LPA observed LIC282 in seven children's file. Child 7 is missing LIC282. LPA discussed SB792 Immunization Requirements and observed licensee and her assistant did not have immunization records of measles and pertussis.

Supervision of children was discussed with 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. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time. Licensee understands if she transports children via vehicle, children cannot be left in parked vehicles unattended at any time.


LPA discussed Zero Tolerance with $500 immediate civil penalty. An ongoing $100 per day per violation continues until the violation(s) is corrected. LPA discussed the requirements of AB633 to licensee and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and licensee understands the requirements. Incidental Medical Services were discussed with the licensee. The licensee is not providing IMS (Incidental Medical Services) at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

LPA reminded the Licensee that effective January 1, 2019 Assembly Bill 2370 requires that all licensed homes 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 Licensee. Safe sleep information & handout was also discussed with the Licensee.

The following type A and B deficiencies were cited on the attached page (809-D). Appeal rights were provided to the Licensees prior to the conclusion of today's inspection. 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.

Notice of site visit was issued and must be posted for 30 days.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: ALVAREZ, GLORIA
FACILITY NUMBER: 434404552
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/19/2019
Section Cited

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102417(g)(4) Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children.
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This requirement was not met as evidenced by LPA observed diaper rash ointment, air fresheners and body sprays accessible to children in the day care room. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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AB633 Parent Notification is required.
This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.

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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 SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 8
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: ALVAREZ, GLORIA
FACILITY NUMBER: 434404552
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2019
Section Cited

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102417(g)(8) Operation of a Family Child Care Home. All homes shall have a current roster of the children.
This requirement was not met as evidenced by LPA did not observe a current roster of the children. This poses a potential risk Health, Safety Personal Rights risk to children in care.
Type B
01/02/2020
Section Cited

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102417(g)(9)(A)(1) Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. This requirement was not met as evidenced by LPA observed a fire and disaster drill log which
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was last completed 10/17/2018. LPA observed licensee filled in dates 04/20/2019 and 10/16/2019. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
01/02/2020
Section Cited

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102421(a) Childs Records. The licensee shall maintain, in each child’s record, the signed and dated notice form LIC 995A, Parents Rights Notice. This requirement was not met as evidenced by Child 7 is missing LIC995A. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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 SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: ALVAREZ, GLORIA
FACILITY NUMBER: 434404552
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2019
Section Cited

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1597.543 Carbon monoxide detectors required; inspection Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

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This requirement was not met as evidenced by LPA observed a carbon monoxide detector in the living room that was not working. Licensee stated sometimes it gets unplugged and plugged it back in. It began to work after.
This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
01/02/2020
Section Cited

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102421(b) Childs Records. The licensee shall maintain, in each child’s record, a copy of the emergency information card required in Section 102417(g) (7). This requirement was not met as evidenced by
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Child 7 is missing LIC700.
This poses a potential risk Health, Safety Personal Rights risk to children in care.
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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 SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 5 of 8
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: ALVAREZ, GLORIA
FACILITY NUMBER: 434404552
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/02/2020
Section Cited

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102418(g) Immunization. Licensee shall document and maintain each child’s immunizations as long as the child is enrolled. This requirement was not met as evidenced by Child 7 is missing immunizations.
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This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
01/02/2020
Section Cited

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An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
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This requirement was not met as evidenced by Child 7 is missing LIC 627. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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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 SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: ALVAREZ, GLORIA
FACILITY NUMBER: 434404552
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/02/2020
Section Cited

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102417(m)(3) Operation of a Family Child Care Home. A file of affidavits signed by each parent with a child enrolled in the home shall be kept by the licensee. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.
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This requirement was not met as evidenced by Child 7 is missing LIC282. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
01/02/2020
Section Cited

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A licensed child care home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of subdivision (a) of Section 1596.893b.
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This requirement was not met as evidenced by Child 7 is missing LIC9224. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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This is a repeat violation of the same section. Civil penalty of $250 is assessed.
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 SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 7 of 8
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: ALVAREZ, GLORIA
FACILITY NUMBER: 434404552
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/02/2020
Section Cited

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1597.622 (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.
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This requirement was not met as evidenced by licensee and her assistant did not have immunization records of measles and pertussis.
This poses a potential risk Health, Safety Personal Rights risk to children in care.
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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 SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 8 of 8