434407223-10-8-2021-07-CC-FCJO-C7LRNY-20211008131106

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434407223
Report Date: 10/08/2021
Date Signed: 10/08/2021 01:11:11 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:	GONZALEZ, LETICIA		FACILITY NUMBER:	434407223
ADMINISTRATOR:	LETICIA GONZALEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 416-7949
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95110
CAPACITY:	14	CENSUS: 9	DATE:	10/08/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Leticia Gonzalez		TIME COMPLETED:	01:20 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(LPA) Fermin Campos-Jaramillo conducted an unannounced annual required inspection to the home today. LPA met with Leticia Gonzalez, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Sunday from 6:00 AM to 6:000 PM. The adults that reside in the home are Licensee, her husband, and her adult children Irma, Rebecca, Jorge, and Janeth. LPA observed licensee's helper Rebecca and licensee's husband Isidro were present in the home. LPA observed eight children in care included five school age, three preschool age, and one infant. Licensee's and licensee's helper Rebecca's CPR and First Aid Certification are current and will expire on 6/30/22 for both of them. LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the Child Care Facility Roster during today's inspection and it is current. LPA reviewed five children's files and are current, including the parents right's form and the immunization records form. LPA reviewed the Fire/Disaster drill log during today's visit and it is current. Last fire drill was documented on 9/14/21 The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas in the home are: Three bedrooms, the attached garage, and one bathroom. LPA observed that the San Jose Fire Department has approved a fire clearance on 9/21/21. LPA observed that licensee has tore off the unlicensed construction within the garage. Off limits out side is a storage shed located in the back yard, and the right side yard. LPA observed the home has a back yard and it is fenced. Licensee uses the back as playground. LPA observed a fully charged 3A40BC fire extinguisher last time serviced on 3/09/21, working smoke detectors and no bodies of water. LPA observed the home is a single story, and there are not wall heaters. LPA observed a working carbon monoxide detector in the home. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. **************Report dated 10/08/21 continues in page 2.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

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: GONZALEZ, LETICIA	FACILITY NUMBER: 434407223
	VISIT DATE: 10/08/2021

NARRATIVE

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Report dated 10/08/21 continues from page 1.
LPA discussed Incidental Medical Services (IMS) with Licensees. LPA observed licensee has in file for herself and for her helpers the required proof of immunization for pertussis, influenza and measles according with the SB792.
A review of staff records on 9/30/21 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, 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.
Supervision of children was discussed with the 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. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a helper must be present. Licensee understands that in absence of a helper her license capacity is reduced to only 8 children and ratio must be observed. Licensee stated she does not transport children via vehicle and that she and her helpers understand that children cannot be left in parked vehicles unattended at any time.
Department website: www.ccld.ca.gov provided to Licensee.
LPA discussed the requirements of AB 633 with the Licensee. LPA also discussed "zero tolerance" related regulations with the Licensee. LPA observed Licensee has in file proof of the required "Mandated Reporter" training, AB1207 for herself and for her helpers. Certificates of completion are dated 2/08/20 and 9/13/20 respectively. LPA provided Licensee with the website address for additional information: www.mandatedreporterca.com
LPA advised licensee of the new regulations on Safe sleep for infant children, and provided licensee with form LIC9227. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

There were not deficiencies cited during today's inspection. Appeal rights was printed and given to Licensee. Exit interview was conducted with licensee in Spanish.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

LIC809 (FAS) - (06/04)

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