434407604-1-16-2020-07-CC-SYIP-BKVSDV-20200116124746

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434407604
Report Date: 01/16/2020
Date Signed: 01/16/2020 12:47:51 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:	ANAYA, CECILIA		FACILITY NUMBER:	434407604
ADMINISTRATOR:	ANAYA, CECILIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 846-6435
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 9	DATE:	01/16/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:54 AM
MET WITH:	Cecilia Anaya		TIME COMPLETED:	12:55 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 Analyst (LPA) Samantha Yip conducted an unannounced annual random inspection. LPA met with Licensee Cecilia Anaya and explained the reason for the inspection. Present during the inspection were Licensee, two Assistant, and 9 children, whom two was infant age. All adults present have fingerprint clearance. License, Emergency Disaster Plan, and Notification of Parent's Rights were observed to posted. There is working phone in the home. The hours of operation are Monday through Friday 7AM to 5PM. LPA toured in the inside and outside of the home. The off-limit areas of the home are the entire upstairs, formal dining room, living room, laundry room, the garage, and the left side of the backyard. The stairs and the fireplace is barricaded to prevent access. The home was observed to be clean and orderly. All disinfectant, cleaning supplies, and other items that are dangerous to children in care were observed to be stored inaccessible to children in care. Furniture and equipment, such as tables and chairs, were age appropriate and in good condition. LPA observed sufficient amount of toy for children in care. Bathroom for children was observed to be clean. LPA observed a fully charged fire extinguisher and smoke detector. The last fire/disaster drill was conducted on 09/2019. Licensee stated that there are no weapons, such as firearms, stored in the home. The backyard is used and is fenced. Play equipment was observed to be in good condition. There were no bodies of water observed during today's inspection. -----------------------continues on 809 dated 01/16/2020 page 2-------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

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: ANAYA, CECILIA	FACILITY NUMBER: 434407604
	VISIT DATE: 01/16/2020

NARRATIVE

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--------------------continuation of 809 dated 01/16/2020 page 1---------------------------------
Licensee does not transport children at this time, but understands that children cannot be left alone and unattended in parked vehicles.

Licensee stated that she currently does not have any children in care who requires Incidental Medical Services (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.

A copy of the facility roster was obtained. 9 children's files were reviewed during today's inspection. The records reviewed include but not limited to consent for emergency medical treatment and immunization records.

Licensee and her Assistant's files were also reviewed. The records reviewed included but not limited to the Mandated Reporter Training and immunization records. Licensee and S-1 has completed the Mandated Reporter Training. S-2 is waiting for Spanish Mandated Reporter Training to come out. LPA also reminded Licensee that the Mandated Reporter Training. Her assistants have their immunization records for measles and pertussis. Licensee stated that she will send a copy of her immunization for measles to Licensing office. Licensee and her assistant have a valid CPR/1st Aid. Licensee's CPR/1st Aid expires on 07/14/2021.

The adults living in the home are Licensee, her spouse, and her son. All adults have cleared criminal record clearance, child abuse index, and TB test results. 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.

LPA reviewed Safe Sleep and Lead Exposure 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.

In areas that were evaluated, no deficiencies have been cited. An exit interview was conducted, where this report was discussed and provided to 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: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

LIC809 (FAS) - (06/04)

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