434405258-8-30-2019-07-CC-JTSE-BFJQNK-20190830121915

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434405258
Report Date: 08/30/2019
Date Signed: 08/30/2019 12:19:21 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:	BARRENECHEA, ISABEL		FACILITY NUMBER:	434405258
ADMINISTRATOR:	BARRENECHEA, ISABEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 737-2813
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY:	14	CENSUS: 5	DATE:	08/30/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Isabel Barrenechea		TIME COMPLETED:	12:30 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	LPA Janet Tse met with licensee Isabel Barrenechea for an annual/random inspection. LPA explained the nature of today's visit to Licensee. Present were five children including four infants with Licensee and her assistant Luz Yanez-Mejia. Licensee's husband was also in the home. Adults living in the home are Licensee and her husband Antonio Barrenechea. Days and hours of operation are Monday to Friday, 7:30am to 5:30pm.. LPA toured the indoor and outdoor of the home. LPA observed a blocked fireplace and no wall heaters. Off limits indoor: master bedroom, master bathroom, one bedroom, laundry room, and the garage. 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. LPA observed a locked storage shed. Off limits outdoor: right side yard. LPA reminded Licensee that she can only have 14 children according to her license. Fire extinguisher is size 3A40BC and filled. Smoke and carbon monoxide 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, car seat laws shall be followed and children are never to be left alone in parked vehicles. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 08/28/2019 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. LPA reviewed five children's files. LPA observed that in each child’s record has a copy of the emergency Facility Evaluation Report 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: 08/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019

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: BARRENECHEA, ISABEL	FACILITY NUMBER: 434405258
	VISIT DATE: 08/30/2019

NARRATIVE

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Facility Evaluation Report dated 08/30/2019 to be continued from previous page:

information card that contains all of the information specified by regulation. LPA observed that Licensee has completed training on preventive health practices, and has current Pediatric CPR/1^st Aid expiring 01/10/2020. A copy of the current roster of the children was provided to LPA today.

Licensee was given a list of the current forms for childcare. Website to download forms and to review Licensing regulations: http://www.ccld.ca.gov. To receive periodic information releases accessible by signing up at: www.myccl.ca.gov. Licensee was provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list: childcareadvocatesprogram@dss.ca.gov.

LPA discussed the immediate civil penalties for Zero Tolerance of $500, and an ongoing $100 per day per violation continues until the violation(s) is corrected. LPA also discussed the Healthy Beverage Act and AB633 requirements for type A violation. SB792 Immunization Requirements was discussed. LPA observed Licensee and her assistant Luz Yanez-Mejia have the required immunization records for measles, pertussis, and TB clearance in file. Licensee opts out of the influenza vaccine. LPA observed the declaration of the influenza vaccine for the Assistant is in file. LPA discussed the Mandated Reporter AB1207 Compliant Child Care Training. Website to complete training: https://mandatedreporterca.com. Licensee's and her assistant's primary language is Spanish, and are currently exempt from the training. 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. Information on Safe Sleep Policy and Lead Poisoning were provided to Licensee. Licensee was advised to provide parents copies of the information.

No deficiency was cited. Notice of site visit was issued and must be posted 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: 08/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019

LIC809 (FAS) - (06/04)

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