434405893-8-14-2019-07-CC-SYIP-BF2MJT-20190814093940

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434405893
Report Date: 08/14/2019
Date Signed: 08/14/2019 09:39:46 AM

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:	AGUILERA, NORMA		FACILITY NUMBER:	434405893
ADMINISTRATOR:	AGUILERA, NORMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 476-1974
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 10	DATE:	08/14/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:41 AM
MET WITH:	Norma Aguilera		TIME COMPLETED:	09:45 AM

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	Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced annual random inspection. LPA met with Licensee Norma Aguilera and explained the reason for the inspection. Present during the inspection were Licensee, her adult helper, and 10 children, whom 2 were infant age. Adults present during today's inspection have fingerprint clearance. License, Emergency Disaster Plan, and Notification of Parents right were observed to be posted. There is working phone in the home. LPA toured in the inside and outside of the home. The off-limit area of the home are the garage, the three bedrooms, and the master bathroom. There are no stairs in the home. There is fireplace, which is barricaded to prevent access by children. The home was clean and orderly. Furniture and other equipment, such as tables, chairs, and play yards, were age-appropriate and in good condition. Bathroom for children's use was sanitary. Disinfectants, cleaning solutions, sharp, and other items that are dangerous to children in care were stored inaccessible and out of reach of children. There is sufficient amount of toys for the children in care. There were no baby walkers or bouncers observed to be in use. Licensee understands baby walkers and bouncers are not permitted in home. LPA observed a fully charged fire extinguisher, functioning smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 05/30/2019. The backyard is fenced and used for outdoor activity space. Outdoor play equipment were age appropriate and in good condition. There are play structures in the backyard, which are anchored to the ground. Licensee stated there is no weapons, such as firearms, stored in the home. LPA discussed with Licensee about dumping out water in sensory tables/water tables after use and about supervision when children are playing with water. LPA did not observe any other bodies of water. --------------continues on 809 dated 08/14/2019 page 2----------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
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: AGUILERA, NORMA	FACILITY NUMBER: 434405893
	VISIT DATE: 08/14/2019

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Licensee does not transport children at this time, but understands that no child shall be left alone and unattended in parked vehicles.

Facility rosters was reviewed and a copy was obtained. 9 children’s files were reviewed during today inspection. The records reviewed included but not limited to the parent's right and immunization records.

Licensee’s CPR/ First Aid expires on 03/31/2020. Licensee's immunization records for pertussis and measles are on file. Licensee completed the Mandated Reporter Training on 03/21/2018. Licensee's helper's file was also reviewed. The records reviewed included but not limited to the immunization records and mandated reporter Training. LPA reminded Licensee that the Mandated Reporter Training needs to be renewed every 2 years.

Adults who are over the age of 18 and reside in the home are Licensee and her adult daughter. All adults living the home have cleared criminal records and child abuse index clearance. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, 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 stated that she currently does not have any children in care who requires IMS services. Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Home Section 102417. 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 also reviewed Safe Sleep information. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

No deficiencies were cited as a result of today's inspection. An exit interview was conducted, where this report was discussed and provided with Licensee.

A NOTICE OF SITE VISIT WAS ISSUE AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
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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