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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434405030
Report Date: 04/25/2019
Date Signed: 04/25/2019 03:45:52 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:GARCIA, BETTYFACILITY NUMBER:
434405030
ADMINISTRATOR:BETTY GARCIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 274-4955
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:14CENSUS: 13DATE:
04/25/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Betty Garica TIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Stephanie Collins and Tuoc Doan conducted an annual inspection. LPAs met with Licensee, Betty Garcia and explained the nature of today's inspection. Present during the inspection was the licensee and Assistant Provider Maria Abad. Present during the inspection were were 13 children in care, of whom two were Infant age. The hours of operation of the day-care are 6:00 AM - 7:30 PM. The Licensee understands the capacity options and understands that the maximum capacity is 14 children. The Licensee also understands the required ratio requirements for the Large Family Child Care Home License

There are two (2) adults residing in the home; Licensee and Licensee's Son Vladamir Garcia. They have Clearance for Criminal Background and Child Abuse Index Checks, and Tuberculosis.

A review of staff records on 04/26/2019 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 has CPR and First Aid, which has an expiration date of 12-31-2020. LPAs observed that the Licensee has record for Measles and Pertussis vaccinations and Licensee has opted out of the flu vaccine. Licensee had completed the online AB1207 Mandated Reporter Training. Licensee understands that the training is to be renewed every two years. Licensee stated that she does transport children at this time. Licensee has a current and valid Driver License.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2019
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 4
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: GARCIA, BETTY
FACILITY NUMBER: 434405030
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2019
Section Cited
CCR
102369(b)(9)
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APPLICATION FOR LICENSE. Licensees and any adult in the home, shall provide evidence of a current tuberculosis clearance, performed and signed by a physician not more than one year prior to or seven days after first day of employment.
This requirement is not met as evidenced by:
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Licensee stated that she will mail to Licensing Office a copy of Assistant Provider Maria Abad's proof of Tuberculosis [TB] Clearance.
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Based on LPAs' review of records, Assistant Provider Maria Abad does not have proof of Clearance for Tuberculosis [TB]. This poses a potential risk to the health and safety of children in care.
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Type B
05/03/2019
Section Cited
CCR
102418(g)
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IMMUNIZATION. Licensee shall document and maintain each child’s immunizations as long as the child is enrolled.
This requirement is not met as evidenced by:
Per LPAs' review of files during inspection, Licensee does not have a copy of the immunization records for Child 1, 2, 3, 4, 5,
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Licensee stated that by 05/03/19 she will mail a copy of Child 1 through 7's immunization record to Licensing Office to show proof of correction.
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and 7. Child 6's immunization's record needs to be updated. This poses a potential risk to the health and safety of 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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: GARCIA, BETTY
FACILITY NUMBER: 434405030
VISIT DATE: 04/25/2019
NARRATIVE
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Licensee understands that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children in care shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system. LPA reviewed 13 children's files. Records reviewed include Family Child Care Home Notification of Parents' Rights forms (LIC 995A), immunization, Emergency Contact Information, and Consent for Emergency Medical Treatment form. The form LIC 282 "Affidavit Regarding Liability Insurance" were kept in the children's file.

LPAs inspected the indoor and outdoor areas of the home today. Smoke and Carbon monoxide detectors were tested and proved to be functioning. LPAs observed a fully charged 2A10BC fire extinguisher. The fireplace is screened. The whole second floor and the Garage on the first floor are Off Limit. LPAs observed a child safety gate installed at the base of the staircase to prevent children from accessing the stairs. Medication, cleaning products and similar items that can pose a danger to children if readily accessible are stored inaccessible to children. LPAs reviewed the facility's roster and obtained a copy. Fire and disaster drills were last conducted and recorded on 12/09/18. Licensee states that there are no weapons in the home. Licensee has one small sized pet dog that is accessible to the day care children. Per Licensee, the dog is current with vaccination. The backyard is fenced and is used for outdoor activities. No bodies of water were observed.

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. .

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

Regulatory violations were observed during the inspection visit. Therefore, citations were issued. Exit Interview was conducted, where this report, the citations, plan of corrections, and appeal rights were discussed and reviewed with Licenseer. 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 KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: GARCIA, BETTY
FACILITY NUMBER: 434405030
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2019
Section Cited
CCR
102421
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CHILD'S RECORD. The licensee shall maintain, in each child’s record, the signed and dated notice form LIC 995A, Parents Rights Notice, [...and] a copy of the emergency information card.
This requirement is not met as evidenced by:
Per LPAs' review of the files, child 7 and 8 do
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Licensee stated that she will mail a copy of the required forms for Child 7 and 8 to Licensing Office to show proof of correction.
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not have the following forms signed and dated:
1) LIC995A Notification of Parent's Rights
2) LIC627 Consent for Emergency Treatment
3) LIC700 Identification & Emergency Info.
4) LIC282 Affidavits Regarding Liability
This poses a potential risk to the health and safety of 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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4