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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407748
Report Date: 08/23/2019
Date Signed: 08/23/2019 04:25:28 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:BACANI, SOLEDAD & DIAZ, CRISTINAFACILITY NUMBER:
434407748
ADMINISTRATOR:S BACANI/C DIAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
4082544870
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:14CENSUS: 5DATE:
08/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Baciani Soledad TIME COMPLETED:
04:24 PM
NARRATIVE
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On August 23, 2019 Licensing Program Analysts (LPA) Stephanie Collins conducted an annual random inspection of the home. LPA met with Licensee, Soledad Bacani and explained the purpose of today's inspection. Present in the home were Licensee's Assistant (Tomasa Dupaya) and (Anselma Callejo)

There were 5 children present. Days and hours of operation are Monday through Friday from 07:00 AM – 6:00 PM. Licensee understands the capacity options.
There are three (3) adults residing in the home; the Licensee, Assistant (Anselma Callejo) and Arlene Huertas.
A review of staff records on August 22, 2019 shows that all individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA 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.

LPA inspected the indoor and outdoor areas of the home today. Smoke and Carbon monoxide detectors were tested and proved to be functioning. LPA observed a fully charged 2A10BC fire extinguisher. Medication, cleaning products and similar items that can pose a danger to children if readily accessible are stored inaccessible to children. LPA reviewed the facility's roster and obtained a copy. Fire and disaster drills were last conducted and recorded on 4-15-19. Off limits areas: Converted garage and all four bedrooms. The backyard is fenced and is used for outdoor activities. Off limit areas; in and round the locked storage shed. The home provides safe toys, play equipment, and materials
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: BACANI, SOLEDAD & DIAZ, CRISTINA
FACILITY NUMBER: 434407748
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2019
Section Cited

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MANDATED REPORTER TRAINING. [...] a person who, on January 1, 2018, is a licensed child care provider [...] shall complete the mandated reporter training provided [...] and shall complete renewal mandated reporter training every two years [...].

This requirement is not met as evidenced by:
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Per LPA' review of the files during inspection, none of the staff or Licensee has has the training certificate. Listensee stated that she was unaware of the training/ requirements.

This poses a potential risk to children's health and safety of children in care.
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Type B
09/06/2019
Section Cited

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HEALTH & SAFETY CODE. Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. [...] shall maintain documentation of the required immunizations.
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This requirement is not met as evidenced by: Based on LPA's review of staff records, Staff do not have documented evidence of immunization against Measles and Pertussis.

This poses a potential risk to the health and safety of children in care.
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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: BACANI, SOLEDAD & DIAZ, CRISTINA
FACILITY NUMBER: 434407748
VISIT DATE: 08/23/2019
NARRATIVE
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Licensee’s Pediatric CPR and First Aid expires on 08/2021. LPA observed that Licensee has proof of immunity against Measles and Pertussis.

LPA reviewed 5 children’s files, Records reviewed include Parents' Rights, immunization, Identification and Emergency Information, and Consent for Emergency Medical Treatment, Family Child Care Home Notification of Parents' Rights, and Affidavit Regarding Liability Insurance.

Licensee states that currently she is not providing Incidental Medical Services. 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. .

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

Safe sleep information was reviewed with Licensee.

LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

Regulatory violations were observed during the inspection visit. Therefore, citations were issued. Exit Interview was conducted, where this report, the citations, plan of corrections, and appeal rights were discussed and reviewed with Licensee. A copy of this report was given to Licensee.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3