434405574-2-9-2023-07-CC-SCOS-CNW2G4-20230209162227

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434405574
Report Date: 02/09/2023
Date Signed: 02/09/2023 04:22:58 PM

Document Has Been Signed on 02/09/2023 04:22 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:	HERNANDEZ, MARIA		FACILITY NUMBER:	434405574
ADMINISTRATOR:	HERNANDEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 729-4974
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY:	14	CENSUS: 5	DATE:	02/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	Maria Hernandez		TIME COMPLETED:	12:45 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	Page 1 Licensing Program Analyst (LPA), Stephanie Collins, conducted an unannounced annual inspection of the Preschool. Family Child Home- (FCCH). LPA met with Licensee Maria, Hernandez and informed her the purpose of the visit. LPA arrived at the facility at 9:02 AM All required posting were observed. Operating days and hours are Monday-Friday 07:30 AM to 05:30 PM. Present during the inspection was the licensee her husband Efrain Hernandez and assistant Yesica Martinez Caballero Hernandez , LPA observed (5) five children being supervised. All adults present were associated to the FCCH. There are (4) four adults residing in the home; Licensee her husband (Efrain Hernandez) with their son Fernando Hernandez and his wife Yesica Martinez Caballero Hernandez and their 3 children. Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

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: HERNANDEZ, MARIA	FACILITY NUMBER: 434405574
	VISIT DATE: 02/09/2023

NARRATIVE

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LPA inspected the home inside and out with Licensee Maria Hernandez .
Smoke and Carbon monoxide detectors were tested and proved to be functioning. LPA observed a fully charged fire extinguisher no bodies of water Fire and disaster drills were last conducted and recorded on 11/17/22. Entire upstairs area is off limits. LPA observed wall heater is discounted. LPA observed the backyard is fully fenced in. There are (2) two storage sheds off limits in the backyard. Licensee states there are no weapons in the home.

Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Restroom for children to use were observed to be in operating conditions.

Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. LPA observed that food storage areas were clean, free of litter, rubbish, and rodents/vermin. Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on.

Drinking water is arranged to be readily available to children. Shade is provided by trees, etc. First Aid kit was inspected. LPA observed and tested Smoke and carbon monoxide detectors which proved to be functioning.

At 10: 13 A M (5) five children’s file were reviewed . Children records reviewed includes: Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Medical Assessment, and immunization.

At 10: 30 AM staff records were reviewed include: Criminal Record and Child Abuse Index Background Check Clearance, TB Clearance, Immunization Record for Measles (MMR) and Pertussis (Tdap) and Mandated Reporter. LPA reminded Licensee that AB1207 Mandated Reporter Training needs to be renewed every two years. Licensee' Pediatric CPR/1st Aid Exp .7/14/2023.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

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: HERNANDEZ, MARIA	FACILITY NUMBER: 434405574
	VISIT DATE: 02/09/2023

NARRATIVE

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This facility provides Incidental Medical Services – Currently the facility does not have any children in care who requires IMS. 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 and reviewed and submitted to Licensee.
LPA discussed the safe sleep regulations with licensee María Hernandez 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 reviewed with Licensee the violations that would result in an immediate $500 civil penalty assessment. Director is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: ccld.ca.gov] to access resources for Providers, Regulations etc.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

In the areas that were evaluated, regulatory violations were observed at the time of the inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Maria Hernandez.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/09/2023 04:22 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: HERNANDEZ, MARIA	FACILITY NUMBER: 434405574
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/09/2023

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 record review), the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/17/2023
	Plan of Correction
1 2 3 4	licensee agreed to submit Mandated reporter Training for Licensee Maria Hernandez and Yesica Martinez Caballero Hernandez on or before POC date.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/10/2023
	Plan of Correction
1 2 3 4	Licensee agreed to submit proof of immunization for C1 on or before POC date

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: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 02/09/2023 04:23 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: HERNANDEZ, MARIA	FACILITY NUMBER: 434405574
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(g)(1)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC809 (FAS) - (06/04)

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