434404782-2-23-2024-07-CC-FRAA-D2QVLG-20240223153155

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404782
Report Date: 02/23/2024
Date Signed: 02/23/2024 03:32:03 PM

Document Has Been Signed on 02/23/2024 03:32 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	PARKS, RUTH		FACILITY NUMBER:	434404782
ADMINISTRATOR:	PARKS, RUTH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 655-9165
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	14	CENSUS: 0	DATE:	02/23/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Ruth Parks		TIME COMPLETED:	12:35 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	On 02/23/2024 at 8:45am, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced Required-3 year inspection. LPA was granted access to the home by Licensee and explained the nature of today’s inspection. Present in the home were licensee and two adults. Licensee provides care to only school age children and LPA did not observe any children during today's inspection. Days and hours of operation are Monday- Sunday, 6:30 am to 5:30 am. Licensee uses the converted garage for daycare purposes and LPA observed required postings in the garage area of the home. The adults that reside in the home are Licensee, spouse and two sons. Licensee has no minor children residing in the home. Licensee submitted an updated Application for a Family Child Care Home License (LIC 279) during today's inspection. LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408-655-9165). LPA observed sufficient materials, toys, and play equipment for the day care children. Furniture, such as tables, chairs and shelves, are in good condition. The home has central heating and wall mounted air conditioning for comfort of children. LPA observed a fireplace barricaded with a bookshelf in the family room. Off limit areas inside the home: entire home. Licensee stated that children sometimes use the family room. Off limit areas outside the home: locked storage shed. Backyard is fenced and both sides of the home are gated. The outdoor space and play equipment were not in good repair. LPA observed that the wood on the play structure was cracking, swings were missing and the tire swing and rope structure were broken. LPA did not observe resilient materials or grass under the swings and high climbing structure. LPA observed several empty gallon bottles lying around. Licensee stated that children have not used the backyard for a long time and may start using it in the summer. Licensee stated that she will clean and repair the backyard prior to allowing access to children. There are no bodies of water observed. LPA observed that the bathroom used by children was in operating condition. The shower area is free of any hazards. During facility inspection, LPA observed the door leading from the converted garage to the left side area of the home was barricaded. LPA advised licensee that the door cannot be barricaded as it may need to be used as an emergency exit when children are in care. Continued on Page 2

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PARKS, RUTH	FACILITY NUMBER: 434404782
	VISIT DATE: 02/23/2024

NARRATIVE

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Licensee stated that they had barricaded the door to treat an infestation and removed the barricade during today's inspection. LPA observed that family room had some cobwebs and was not cleaned. Licensee stated that after school pick up children are taken to the park and on field trips and mostly use the garage area. LPA informed licensee that all areas of the home used by children need to be safe, clean and in good repair. LPA observed a fully charged 2A10BC fire extinguisher and working smoke/carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, poisons, medications, sharp objects and other similar items were observed to be stored inaccessible to children. Licensee understands that smoking is prohibited in the home.

Store bought drinking water is readily available for children in the home. Licensee states that she provides meals and snacks to the children in care. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated. Licensee states that a child will be isolated in the family room if necessary due to illness/communicable disease.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was last conducted on 10/03/2023. LPA obtained copy of children's roster.

Children file review was completed. Seven (7) children’s files were reviewed during today's inspection. Licensee does not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282).During file review, LPA observed children (C3-C6) were missing the Consent for Emergency Medical Treatment (LIC 627) and Affidavit Regarding Liability Insurance (LIC 282).

LPA discussed the safe sleep regulations with licensee, including conducting 15-minute checks on all sleeping infants and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. 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. LPA provided licensee with a copy of an Individual Infant Sleeping Plan (LIC 9227) for infants 12 months and under and a sample 15- minute sleeping infant check form for children under 2 years of age.

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SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PARKS, RUTH	FACILITY NUMBER: 434404782
	VISIT DATE: 02/23/2024

NARRATIVE

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LPA reviewed two (2) staff files (Licensee and one adult assistant) for the required forms. A review of staff records 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 has current Pediatric CPR/First Aid certification (expires 4/29/2025). Licensee's Mandated Reporter Training expires on 10/13/2025. LPA observed Licensee is missing proof of immunization for MMR and assistant does not have the required forms including Mandated Reporter training and proof of immunization's. Licensee understands the mandated reporter training is mandatory to all Licensees and adults in the home in contact will children and requires renewal every two years. LPA referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training.

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.

Supervision of children was discussed with Licensee, and she understands that she or a qualified adult 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 the home at any time and a qualified assistant must be present. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed. LPA provided a children's capacity and ratio worksheet to licensee during today's inspection.

Licensee is encouraged to visit the Department’s website at https://cdss.ca.gov/inforesources/child-care-licensing to access general updates, resources for providers, regulations, adoptions of new laws, pay annual fees etc. The Department will communicate all new information to providers through Provider Information Notices (PINs).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Continued on Page 4

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

LIC809 (FAS) - (06/04)

Page: 3 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: PARKS, RUTH	FACILITY NUMBER: 434404782
	VISIT DATE: 02/23/2024

NARRATIVE

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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: https://www.ada.gov/resources/child-care-centers/.

Licensees stated that they transport children. LPA reminded Licensee that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system. Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

Three (3) Type B deficiencies and two (2) Technical Violations (TV) were cited today on the attached LIC 809D pages. Appeal rights were printed and provided to Licensee. LPA reminded Licensee that failure to correct deficiencies by Plan of Correction Due Date may result in civil penalties.Exit interview conducted and report was reviewed with the licensee, Ruth Parks.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/23/2024 03:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: PARKS, RUTH	FACILITY NUMBER: 434404782
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above for assistant staff which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/08/2024
	Plan of Correction
1 2 3 4	Licensee will have assistant complete the mandated reporter training and submit proof to LPA by Plan of Correction date of 03/08/2024.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above for licensee and assistant which poses a potential health, safety or personal rights risk to persons in care. Licensee did not have proof of immunizations for MMR (measles) and no proof of immunizations for Tdap, MMR and Influenza were observed for assistant.
	POC Due Date: 03/08/2024
	Plan of Correction
1 2 3 4	Licensee will submit required proof of immunizations for herself and staff to LPA by Plan of Correction date of 03/08/2024.

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: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 02/23/2024 03:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: PARKS, RUTH	FACILITY NUMBER: 434404782
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(m)(3)

Operation of A Family Child Care Home

(3) A file of affidavits signed by each parent with a child enrolled in the home. 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above for children (C3-C6) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/08/2024
	Plan of Correction
1 2 3 4	Licensee will have parent complete required forms including Consent for Emergency Medical Treatment (LIC 627) for children (C3-C6) and submit to LPA by Plan of Correction date of 03/08/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

LIC809 (FAS) - (06/04)

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