434407797-11-6-2019-07-CC-JTSE-BHNU6V-20191106141858

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434407797
Report Date: 11/06/2019
Date Signed: 11/06/2019 02:19:05 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:	PEREZ, HERLINDA		FACILITY NUMBER:	434407797
ADMINISTRATOR:	PEREZ, HERLINDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 998-4531
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	14	CENSUS: 9	DATE:	11/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Herlinda Perez		TIME COMPLETED:	02:30 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	LPA Janet Tse met with licensee Herlinda Perez for an annual/random inspection. LPA explained the nature of today's visit to Licensee. Present were nine children including one infant and four school age with Licensee and her assistant Yessica Hernandez Mayorga. Present was also Licensee's adult son Angel Perez. Adults living in the home are Licensee, her husband, two adult sons, and one adult daughter with a 16-year-old child. Days and hours of operation are Monday to Friday, 6:00am to 6:00pm and emergency only on the weekends. LPA toured the indoor and outdoor of the home. LPA observed a covered fireplace and no wall heaters. LPA observed no stairs. Off limits indoor: two bedrooms. One of the three bedrooms is used for child care. There is no bodies of water. Licensee stated there is no firearms/weapons in the home. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children. Outdoor area is fenced. Off limits oudoor: the detached garage, storage room, basement, and left side yard. Licensee understands that the entrance to the garage, the storage room, and the basement shall remain locked during day care hours. LPA reminded Licensee that she can only have 14 children according to her license. Fire extinguisher is size 2A10BC and filled. Smoke and carbon monoxide detector is operable. Home is clean and orderly with heating and ventilation for safety and comfort. LPA observed sufficient materials, toys, and play equipment for the day care children. Telephone is in working order. Children were supervised on the visit and LPA went over substitute options. LPA also discussed if Licensee transports children, they are never to be left in parked vehicles. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 11/05/2019 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background checks have received criminal clearances and child abuse index clearances or exemptions. Facility Evaluation Report dated 11/06/2019 to be continued on next page:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

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: PEREZ, HERLINDA	FACILITY NUMBER: 434407797
	VISIT DATE: 11/06/2019

NARRATIVE

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Facility Evaluation Report dated 11/06/2019 to be continued from previous page:

LPA observed a current fire drill log which is to be done every 6 months. LPA was provided a copy of a current roster of the children. LPA observed that Licensee and her assistant have current Pediatric CPR/1^st Aid expiring 03/02/2021.

Licensee was given a list of the current forms for childcare. Website to download forms and to review regulations: http://www.ccld.ca.gov. An updated LIC 279 Application for a Family Child Care Home License was provided to LPA today.

LPA discussed the immediate civil penalties for Zero Tolerance of $500, and an ongoing $100 per day per violation continues until the violation(s) is corrected. LPA also discussed the Healthy Beverage Act and AB633 requirements for A violations. AB792 Immunization Requirements was discussed. LPA observed the required immunization records for Licensee and her assistant were in file. Incidental Medical Services were discussed with the licensee. The licensee is not providing IMS (Incidental Medical Services) at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

Effect of Lead Exposure handout dated 1/20/19 given during today’s inspection. Licensee understands that per Assembly Bill (AB 2370), written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians. LPA reviewed infants safe sleep policies with Licensee and provided "A Child Care Provider's Guide to Safe Sleep.” More information can be found at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing. The Mandated Reporter AB1207 Compliant Child Care Training was also discussed. Website to complete training: https://mandatedreporterca.com. Licensee's and her assistant's primary language is Spanish and are currently exempt from the training.

Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates. Periodic information releases accessible by signing up at: www.myccl.ca.gov.

No deficiency was cited. Notice of site visit was issued and must be posted for 30 days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

LIC809 (FAS) - (06/04)

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