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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407604
Report Date: 04/07/2022
Date Signed: 04/07/2022 04:51:50 PM


Document Has Been Signed on 04/07/2022 04:51 PM - It Cannot Be Edited

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, CECILIAFACILITY NUMBER:
434407604
ADMINISTRATOR:ANAYA, CECILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 846-6435
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 6DATE:
04/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cecilia AnayaTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required-1 Year inspection. LPA met with Licensee Cecilia Anaya and explained the reason for the inspection. Present during today's inspection were Licensee, an assistant, one volunteer, and 6 children. Licensee's son was also present during today's inspection. Licensee stated that she has not had her volunteer obtain a fingerprint yet. The volunteer is a relative of one of the child attending. Licensee stated that she will have volunteer obtain fingerprints. Licensee also understands that the volunteer cannot be present until her fingerprints are cleared.

There is board to post required posting. 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 inside in the home are family dining room, living room, laundry room, garage, and the entire upstairs. There are stairs and a fireplace, which are barricaded. All disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible. LPA observed that there were graters and peelers in the kitchen drawers, which Licensee moved during today's inspection. LPA also observed that there was a hair trimmer in the children's bathroom. Licensee moved the hair trimmer upstairs, which is off-limits. There are toys for children. There is fully charged fire extinguisher and a functioning smoke detector. Licensee stated that she is going to send LPA the manual for her detector to confirm whether it is also a carbon monoxide detector. Licensee understands that she needs to have at least one carbon monoxide detector. Licensee stated that she will obtain a carbon

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SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
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: 04/07/2022
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monoxide detector if the detector is not a carbon monoxide detector and send proof to Licensing. Licensee stated that there are no weapons, such as firearms, stored in the home.

The backyard is used and is fenced. LPA observed that the plastic play structures and play house were starting to crack; along with the lid for the sand/water table. Cracks were not sharp. Licensee placed duct tape over the crack during inspection. There were no bodies of water observed during today's inspection.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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


Licensee does not transport children, but understands that children cannot be left alone and unattended in parked vehicles.


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SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
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: 04/07/2022
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A copy of the facility roster was obtained. Six children's files were reviewed. The records reviewed include but not limited to identification and emergency contact and notification of parent's rights.

Licensee and her assistant's files' were also reviewed during today's inspection. Licensee and her Assistant both completed the Mandated Reporter training. Licensee completed the Mandated Reporter training on 08/08/2020 and her assistant completed it on 01/21/2022. LPA reminded Licensee that the Mandated Reporter training requires renewal every two years. Licensee and her assistant have a valid CPR/1st Aid. Licensee's CPR/1st Aid expires on 06/09/2023 and her assistant's CPR/1st Aid expires on 03/06/2023. Licensee and her assistant's immunization records are on file.

The adults 18 and over living in the home are Licensee, her spouse, and her adult son. All adults have cleared fingerprints and TB clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA Samantha Yip informed licensee Cecilia Anaya that this report dated 04/07/2022 document one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Samantha Yip informed the licensee to provide a copy of this licensing report dated 04/07/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

As a result of this inspection, one Type A citation was issued and a civil penalty of $100 for caregiver background check was assessed. Exit interview conducted and report was reviewed with the licensee Cecilia Anaya. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 04/07/2022 04:51 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 2 people which poses an immediate health, safety or personal rights risk to persons in care. Licensee had a volunteer who has not obtain fingerprints yet.
POC Due Date: 04/08/2022
Plan of Correction
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By POC 04/08/2022, Licensee will have volunteer obtain fingerprint and send proof to Licensing. Licensee understands that her volunteer cannot return until her fingeprints are cleared.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
LIC809 (FAS) - (06/04)
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