434405893-7-14-2021-07-CC-SYIP-C4WRPU-20210714131228

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434405893
Report Date: 07/14/2021
Date Signed: 07/14/2021 01:12:35 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:	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: 3	DATE:	07/14/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Norma Aguilera		TIME COMPLETED:	01:15 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	Licensing Program Analysts (LPAs) Samantha Yip and Cortney Nelson conducted an unannounced Required-1 Year inspection. LPA met with Licensee Norma Aguilera and explained the purpose of this inspection. Present during today's inspection were Licensee and three children. There is a board to post required posting. The hours of operation of Monday through Friday 7:30AM to 5:30PM. There is working phone in the home. LPAs toured in the inside and outside of the home with Licensee. The off-limit areas of the home are the garage, two bedrooms, the shed outside, the left side of the home. LPA reminded Licensee to ensure that off-limit areas are inaccessible to children, such as bedroom and shed. There is a fireplace, which is barricaded. All cleaning supplies, disinfectants, items that could pose a risk to children were inaccessible to children. The home was observed to be clean. Toys and equipment were observed to be in good conditions. There were no baby walkers observed during today's inspection. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 02/08/2021. Licensee stated that there is no weapons, such as firearms, stored in the home. Licensee does have a pet in the home. The backyard is used and is fenced. There is play structure, which is anchored to the ground. There were no bodies of water observed during today's inspection. -----------------------continues on 809 dated 07/14/2021 page 2-----------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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: 07/14/2021

NARRATIVE

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---------------------CONTINUATION OF 809 DATED 07/14/2021 PAGE 1------------------------

Licensee stated that she does not transport children, but understands that children cannot be left alone and unattended in parked vehicles. Licensee also stated she is not providing Incidental Medical Services (IMS) at this time. Plan for Providing IMS is on file.

A copy of the facility roster was obtained. 3 children's file were reviewed during today's inspection. The records reviewed included but not limited to Emergency Contact card.

Licensee has a valid CPR/1st Aid card, which expires on 03/15/2022. Licensee completed the Mandated Reporter training on 03/10/2020. Licensee's immunization records for measles and pertussis are in file.

The adults living in the home are Licensee and her two adult children. All adults are have cleared criminal record clearance, child abuse index, or exemption, and TB test. 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.

As a result of this inspection, no deficiencies have been cited. An exit interview was conducted where this report was discussed and provided to Licensee Norma Aguilera. A Notice of Site Visit has been issued and must be 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: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC809 (FAS) - (06/04)

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