434408081-1-6-2020-07-CC-TDON-BKL2NN-20200106163303

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408081
Report Date: 01/06/2020
Date Signed: 01/06/2020 04:33:18 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:	CULCASI, MICHELE & ROBERT		FACILITY NUMBER:	434408081
ADMINISTRATOR:	CULCASI, MICHELE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 733-6739
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY:	14	CENSUS: 8	DATE:	01/06/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Michele Culcasi		TIME COMPLETED:	04:40 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) Tuoc Doan conducted an unannounced Annual Inspection of the Family Day Care home. LPA met with Licensee Michele Culcasi and explained to her the purpose of the inspection. Assistant Provider Sandra Contreras and Licensee Robert Culcasi were also present during the inspection. There were eight children in care, of whom three were under two years old. The home’s operating days and hours are Monday through Friday from 07:00 AM to 06:00 PM. The home maintains telephone service. The License and Notification of Parents’ Rights were observed to be posted. The home was inspected inside and out. The home was clean and orderly. LPA did not observe flies, other insects, or rodents during the inspection. The observed children’s toys, play equipment, and furniture were in good condition. There were no baby walkers at the day care. Restroom used by children was observed to be clean and in operating condition. Food preparation area was clean. Areas used for day care are all three Bedrooms, Living Room, Dining Room, Kitchen, and Powder/Restroom adjacent to the Laundry room. The backyard is fenced and it is divided into two areas; one for day care outdoor activity and the other area where the pool and hot tub are located at are off limits. Both the swimming pool and hot tub are surrounded by a fence. Licensee stated that there were no weapons stored on the premises. A fully charged fire extinguisher was observed. Carbon monoxide and Smoke Detectors were tested and proved to be functioning. Fire/Disaster Drill log recorded that the last drill was conducted on 12/02/2019. Licensee Michele Culcasi stated that she provides transportation to the children. Licensee Michele Culcasi has a current and valid Driver License. Licensee understands that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children in care shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020

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: CULCASI, MICHELE & ROBERT	FACILITY NUMBER: 434408081
	VISIT DATE: 01/06/2020

NARRATIVE

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The home has a pet dog. Per Licensee, the dog is vaccinated.

LPA reviewed and obtained a copy of the roster of children. Children’s files were reviewed, which included records of Identification and Emergency Information, Consent for Emergency Medical Treatment, Receipt for Parents' Rights Notice, and Immunization. Licensees and Assistant Provider Sandra Contreras files were reviewed, which included record for Criminal and Child Abuse Background Check Clearance, immunization, required Training etc. Licensee Michele Culcasi's AB1207 Mandated Reporter Training Certificate expires on 11/27/2020 and her Pediatric CPR/1st Aid Certificate expires on 11/21/2021.

Both Licensees are the only adults residing in the home. They have Clearances for Tuberculosis, and Criminal Background and Child Abuse Index Checks. 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. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

LPA reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoptions of new laws, pay annual fees etc.
LPA reminded Licensee of the requirement of the “Lead Poisoning Facts Information Flyer” and Safe Sleep information was also reviewed with Licensee.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she currently does not have any children in care who requires 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) & link to Commonly Asked Questions and the ADA, available at:<http://www.ada.gov/childqanda.htm> .

In the areas that were evaluated, no regulatory violations were observed at the time of the inspection.
Exit interview was conducted, where this report was reviewed with Licensee Michele Culcasi.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020

LIC809 (FAS) - (06/04)

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