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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434405691
Report Date: 05/31/2019
Date Signed: 05/31/2019 12:49:38 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:LAMAS, CRISTINAFACILITY NUMBER:
434405691
ADMINISTRATOR:CRISTINA LAMASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 937-4523
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:14CENSUS: 9DATE:
05/31/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Cristina LamasTIME COMPLETED:
12:50 PM
NARRATIVE
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LPAs Janet Tse and Peter Tinkelenberg met with licensee Cristina Lamas for an annual/random inspection. LPAs explained the nature of today’s visit to her. LPA observed nine children including two infants in the home with Licensee and her assistant (ML) during today’s visit. Days and hours of operation are Monday to Friday, 6:00am to 6:00pm. The adults that reside in the home are Licensee, her husband, her daughter, and her brother.

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 05/29/2019 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. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensee shall immediately removes the individual and prevents them from returning to the home or having contact with children in care.

LPAs toured the indoor and outdoor areas of the home during today’s inspection. LPAs observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPAs observed an electric fireplace in the living room which is no in use per Licensee. LPAs observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items are stored inaccessible to children. LPAs observed a fully charged 2A10BC extinguisher and working smoke and carbon monoxide detectors. Licensee stated there are no weapons/firearms in the home. Off limit areas indoor: master bedroom, master bathroom, two bedrooms, and laundry room. The living room and one of the four bedrooms will be used for infant napping only. LPAs observed a fenced backyard and no bodies of water. Off limit areas outside the home: left side yard.

LPAs observed Licensee has completed training on preventive health practices, and has current CPR and First
Facility Evaluation Report dated 05/31/2019 to be continued on next page:
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
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: LAMAS, CRISTINA
FACILITY NUMBER: 434405691
VISIT DATE: 05/31/2019
NARRATIVE
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Facility Evaluation Report dated 05/31/2019 to be continued from previous page:
Aid certification expiring 09/16/2019. The assistant's (ML) CPR & 1st Aid certification expires on 05/16/2020. LPAs observed the roster of the children is not current. The last fire and disaster drill which is to be done at least once every six months was practiced on 05/28/2019 and was documented on a log. LPAs reviewed eight children files. LPAs observed one of the nine children present (child #9) does not have a child's file which includes LIC 700 Identification & Emergency Information, LIC 627 Consent for Medical Treatment, PM 286 Immunization Records, and LIC 995A Notification of Parents' Rights. LPAs observed children’s immunization records for children #2, 3, 4, 6, 7, 8, and 9 were not documented, maintained, and/or updated in form PM286. LPAs observed Notification of Parents’ Rights is in each child’s file except for child #9. Licensee carries liability insurance for child care.
Supervision of children was discussed with licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time. Licensee states that she transports children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time. Licensee understands the car seat laws.
A list of Family Child Care Home Licensing forms was provided and explained to Licensee prior to the conclusion. Department website: http://ccld.ca.gov provided to Licensee to download forms, review regulations, and obtain Licensing information. Licensee was advised of the Safe Sleep practice and Lead Poisoning; and information regarding those issues were provided to Licensee today.
LPAs also discussed "zero tolerance" related regulations with Licensee and advised her of the assessment of an immediate $500 civil penalty for any violation of a "zero tolerance" related regulation; and an ongoing civil penalty of $100 per day per violation continues until the violation(s) is corrected. 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. 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. SB792 Immunization Requirements was also discussed. LPAs observed the required immunization records for Licensee and her assistant (ML) are in file. LPAs observed Licensee and her assistant (ML) have completed the Mandated Reporter AB1207 Compliant Child Care Training on 12/12/2018 and 12/13/2018 respectively. Website to complete the training: ttps://mandatedreporterca.com. Licensee's and her assistant's primary language is Spanish, and are currently exempt from the requirement to complete the training. Licensee stated that she will take the training again once the training in Spanish becomes available.

Deficiencies were cited. Notice of site visit was issued and must be posted for 30 days.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: LAMAS, CRISTINA
FACILITY NUMBER: 434405691
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2019
Section Cited
CCR
102417(g)(7)
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An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for
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Licensee shall maintain a child's file for each child enrolled. Licensee shall forward a copy of the LIC 627 Consent for Medical Treatment for child #9 to LPA by 06/10/2019 due date.
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the licensee or registrant to consent to emergency medical care.
This requirement was not met as evidenced by: LPAs observed no LIC 627 Consent for Medical Treatment for child #9. Child #9 does not have a child's file.
This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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Type B
06/10/2019
Section Cited
CCR
102418(g)
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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.
This requirement was not met as evidenced by:
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Licensee shall forward copies of the PM 286 for children #2, 3, 4, 6, 7, 8, and 9 with current immunization records to LPA by 06/10/2019 due date.
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LPAs observed children’s immunization records for children #2, 3, 4, 6, 7, 8, and 9 are not documented, maintained, and/or updated in form PM286.

This poses a potential risk to the Health, Safety, or Personal Rights 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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: LAMAS, CRISTINA
FACILITY NUMBER: 434405691
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2019
Section Cited
CCR
102417(g)(8)
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Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement was not met as evidenced by:
LPAs observed the roster of the children is not current.
This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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Licensee shall maintain a current roster of children and keep the record for at least three years. Licensee shall forward a copy of the current roster of the children to LPA by 06/10/2019 due date.
Type B
06/10/2019
Section Cited
CCR
102421(b)
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The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7).

This requirement was not met as evidenced by:
LPA observed child #9 does not have a child's file which includes LIC 700 Identification &
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Licensee shall maintain a child's file for each child enrolled. Licensee shall forward a copy of the LIC 700 Identification & Emergency Information for child #9 to LPA by 06/10/2019 due date.
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Emergency Information.

This poses a potential risk to the Health, Safety, or Personal Rights 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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: LAMAS, CRISTINA
FACILITY NUMBER: 434405691
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2019
Section Cited
CCR
102419(d)
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At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parents’ Rights, LIC 995A (8/06),
This requirement was not met as evidenced by:
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Licensee shall maintain a child's file for each child enrolled. Licensee shall forward a copy of the LIC 995A Notification of Parents' Rights for child #9 to LPA by 06/10/2019.
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LPAs observed child #9 does not have a child's file. There is no LIC 995A Notification of Parents' Rights for child #9.

This poses a potential risk to the Health, Safety, or Personal Rights 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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5