434405203-8-14-2019-07-CC-JTSE-BF2W4Y-20190814165818

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434405203
Report Date: 08/14/2019
Date Signed: 08/14/2019 04:58:31 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:	GARCIA, RAMONA		FACILITY NUMBER:	434405203
ADMINISTRATOR:	GARCIA, RAMONA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 972-5610
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	14	CENSUS: 11	DATE:	08/14/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Ramona Garcia		TIME COMPLETED:	05:00 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	LPAs Janet Tse and Susy Cervantes met with licensee Ramona Garcia for an annual/random inspection. LPAs explained the nature of today's visit to Licensee. At arrival, LPAs observed ten children including four infants and two school age with Licensee alone. Licensee was operating out of capacity/ratio. Another child was dropped off by the mother during the later part of the inspection. Licensee's daughter Viviana Garcia arrived at the home later from work at 2:19pm. Licensee stated that her daughter is also her assistant. Adults living in the home are Licensee, her husband, her daughters with two children ages eight months and 14 years old. Days and hours of operation are Monday to Friday, 6:00am to 6:00pm. LPAs toured the indoor and outdoor of the home. LPAs observed a barricaded wall heater in the day care room. LPAs observed part of the upper molding of the wall was missing, and spray foam insulation was exposed. Off limits indoor: master bedroom, two bedrooms, master bathroom, and one bedroom. There are no bodies of water. Licensee stated there is no firearms/weapons in the home. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children. Backyard is fenced. LPAs observed a 9' x 12' 2'' storage shed with stucco and roofing in the back yard. Due to the location, construction, and the size of the storage shed, fire clearance will be ordered to ensure it is in compliance with city codes for the safety of the day care children. LPAs also observed a covered patio with electrical wiring. LPAs observed a dog in the backyard. Licensee stated the dog is vaccinated. Off limits outdoor: laundry room and both side yards. LPA reminded licensee that she can only have 14 children with an assistant according to her license. Fire extinguisher is size 3A40BC and filled. Carbon monoxide and smoke detectors are operable. Home is clean and orderly with heating and ventilation for safety and comfort. LPA observed sufficient materials, toys, and play equipment for the day care children. Telephone is in working order. Children were supervised on the visit and LPA went over substitute options. LPA also discussed if licensee transports children, they are never to be left in parked vehicles. Facility Evaluation Report dated 08/14/2019 to be continued on next page:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019

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: GARCIA, RAMONA	FACILITY NUMBER: 434405203
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/14/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/15/2019 Section Cited CCR 102416.5(a)	1 2 3 4 5 6 7	Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee shall immediately cease operating out of capacity/ratio. Licensee shall forward a written plan of correction to LPA by 08/15/2019 due date with plans and procedures to ensure that the child care home is within capacity/ratio at all times. Licensee shall also forward a copy of the children's attendance and assistats' work schedules to LPA.
	8 9 10 11 12 13 14	At arrival, LPAs observed ten children including three infants and two school age with Licensee alone. Licensee was operating out of capacity/ratio. This poses an immediate risk to the Health, Safety, or Personal Rights of children in care.	8 9 10 11 12 13 14	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.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019

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, RAMONA	FACILITY NUMBER: 434405203
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/14/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/29/2019 Section Cited CCR 102417(g)	1 2 3 4 5 6 7	Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child. This requirement was not met as evidenced by: LPAs observed part of the upper molding of the wall was missing, and spray foam insulation was exposed.	1 2 3 4 5 6 7	Licensee shall repair the wall and cover the spray foam insulation. Licensee shall forward a picture of the wall repaired to LPA by 08/29/2019 due date.
	8 9 10 11 12 13 14	This poses a potential risk to the Health, Safety, or Personal Rights of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019

LIC809 (FAS) - (06/04)

Page: 4 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, RAMONA	FACILITY NUMBER: 434405203
	VISIT DATE: 08/14/2019

NARRATIVE

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Facility Evaluation Report dated 08/14;2019 to be continued from previous page:

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 08/13/2019 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions.

LPAs reviewed 11 children's files. LPAs observed that in each child’s record has a copy of the emergency information card. LPA observed Licensee has current Pediatric CPR/1^st Aid expiring 07/21/2021. A copy of the current roster of the children was provided to LPAs. Licensee was given a list of the current forms for childcare. Website http://www.ccld.ca.gov to download forms, review regulations, and obtain additional Licensing information. Information on Safe Sleep Practice and Lead Poisoning was provided to Licensee.

SB792 Immunization Records was discussed. The required immunization records are in file. LPA discussed the immediate civil penalties for Zero Tolerance of $500. An ongoing $100 per day per violation continues until the violation(s) is corrected. LPA discussed the Healthy Beverage Act and AB633 requirements for type A violations. 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. Licensee's primary language is Spanish and is currently exempt from the Mandated Reporter AB1207 Compliant Child Care Training. Website to complete training: https://mandatedreporterca.com.

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. Upon receipt, Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Deficiencies were cited. Notice of site visit was issued and must be posted with type A deficiency cited for 30 days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019

LIC809 (FAS) - (06/04)

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