434407791-4-20-2023-07-CC-SYIP-CR3R3W-20230420124034

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434407791
Report Date: 04/20/2023
Date Signed: 04/20/2023 12:40:41 PM

Document Has Been Signed on 04/20/2023 12:40 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:	PRIETO, SALLY		FACILITY NUMBER:	434407791
ADMINISTRATOR:	PRIETO, SALLY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 847-7644
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 1	DATE:	04/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:57 AM
MET WITH:	Sally Prieto		TIME COMPLETED:	12:05 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 Required- 1 Year inspection. LPA met with Licensee Sally Prieto and explained the reason for the inspection. Present during today's inspection were Licensee, her spouse, and one daycare child. Her assistant arrived shortly after. All adults present have cleared fingerprints. There is an area to post required postings, such as license and notification of parent's rights. The hours of operation are Monday through Friday 7:30AM to 6PM. There is working phone in the home. LPA toured the inside and outside of the home with Licensee. The off-limit areas of the home are the garage and master bedroom. There is a fireplace in the home, which is barricaded. Disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible to children. LPA reminded Licensee that any disinfectant sprays or wipes need to be inaccessible to children. There are toys and equipment for children. There were no baby walkers observed during today's inspection. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 04/07/2023. Licensee stated that there are no weapons, such as firearms, stored in the home. The backyard is used and is fenced. The off-limit areas outside are the side yard and the grass area next to the patio/child play area. There were no bodies of water observed during today's inspection. LPA reminded Licensee to ensure that any areas off-limits are inaccessible. ------------------continues on 809 dated 04/20/2023 page 2-----------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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 4

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: PRIETO, SALLY	FACILITY NUMBER: 434407791
	VISIT DATE: 04/20/2023

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
26
27
28
29
30
31
32

---------------continuation of 809 dated 04/20/2023 page 1-------------------

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. Licensee and her assistant do 15 minute sleep checks for sleeping infants, but does not document the date, name of the infant, and the time checked. PIN 20-22 and a example of sleep check log was provided to Licensee. Each infant has their own individual play yard and do not share play yard.

Licensee does not provide Incidental Medical Services (IMS). For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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's spouse transport children and has a valid driver's license. Licensee understands that children cannot be left alone and unattended in parked vehicles.
A copy of the facility roster was obtained. One (1) children's file was reviewed during today's inspection. The records reviewed include but not limited immunization records and parent's rights.

---------------continuation of 809 dated 04/20/2023 page 3---------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: PRIETO, SALLY	FACILITY NUMBER: 434407791
	VISIT DATE: 04/20/2023

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
26
27
28
29
30
31
32

----------------continuation of 809 dated 04/20/2023 page 2---------------------

Licensee, her spouse, and her assistant's files were reviewed during today's inspection. The records reviewed include but not limited to Mandated Reporter training and immunization records. Her assistant is missing her immunization record for measles. Licensee stated that she will have her assistant obtain immunization record for measles and send proof to Licensing. Licensee, her spouse, and her assistant all have valid CPR/1st Aid. Licensee's CPR/1st Aid expires on 09/27/2023.

The adults 18 and over living in the home are Licensee and her spouse. All adults have cleared fingerprints. 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.

Licensee will submit the following:
- sleep log for infant
- immunization record for assistant

As a result of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Licensee Sally Prieto. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 04/20/2023 12:40 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: PRIETO, SALLY	FACILITY NUMBER: 434407791
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above in one out of one persons, which poses a potential health, safety or personal rights risk to persons in care. Licensee and her assistant check infants, but does not document it.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	BY POC 04/28/2023, Licensee will document the date, name of the child, and time check for infant and submit sleep log to Licensing.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4