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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408195
Report Date: 11/16/2021
Date Signed: 11/19/2021 11:37:48 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:FORTES, ELOISA & SANTINOFACILITY NUMBER:
434408195
ADMINISTRATOR:FORTES, ELOISA & SANTINOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 934-9209
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:14CENSUS: 1DATE:
11/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:54 PM
MET WITH:Eloisa and Santino FortesTIME COMPLETED:
05:00 PM
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On Tuesday, November 16, 2021 at 3PM, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 Year Visit. LPA met with the Licensee Eloisa and Santino Fortes and explained the nature of site visit. Present on this visit were 1 preschool child and 2 school age children. Facility operates from Monday to Friday from 7:30 am to 5:30 pm.

LPA toured the home to conduct a health and safety inspection with the Licensee. The home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. Facility’s License and Notification of Parents’ Rights were observed to be posted. The ON LIMIT Areas are the Converted Garage to a Day Care Room, Day Care Bathroom, Dining Area, Kitchen, Living Room, and Backyard. The backyard play area is completely fenced. The OFF-LIMIT AREAS are all bedroom, master bathroom and hallway bathroom which will be inaccessible to children in care by closed and or locked doors and or a fence with visual supervision. Outdoor activity space and play equipment were observed to have been maintained in safe condition and free of hazards. There were no bodies of water observed. Storage sheds in the backyard were locked. Licensees stated that there were no weapons such as firearms stored on the premise. Children’s toys, play equipment and materials were safe and age appropriate. Furniture and equipment, such as tables, chairs, cots, and step stool were age appropriate and in good condition. Fireplace was blocked off to prevent access by children. LPA observed no baby walkers or bouncers on the premise. Facility has one dog, a Maltese Poodle mix. Per Licensee, the dog is vaccinated and is kept inside the home.

Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children in care were stored inaccessible to children. Facility appeared to be free of flies, other insects, and rodents during today’s inspection. A fire extinguisher, and carbon monoxide and smoke detectors were observed. Smoke and Carbon monoxide detectors were tested and they were functioning. Fire drill is conducted every three months.

SEE 809 C.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: FORTES, ELOISA & SANTINO
FACILITY NUMBER: 434408195
VISIT DATE: 11/16/2021
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CONTINUATION....

LPA discussed the following;

Santa Clara County Office of Education Childcare Resource & Referral Program, 1290 Ridder Park Drive San Jose, CA 95131-2304 Email: childcarescc@sccoe.org Phone: 669-212-KIDS (5437)https://www.childcarescc.org/child-care-application



For questions about registration or your stipend, please call 1-833-398-1399 Hours of operation are 6:00am – 6:00pm CST ARPASurvey@cde.ca.gov

LEAD TESTING OF WATER
https://cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

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 [facility representative] 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.

There are no deficiencies cited on this visit

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensees Eloisa and Santino Fortes.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: FORTES, ELOISA & SANTINO
FACILITY NUMBER: 434408195
VISIT DATE: 11/16/2021
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CONTINUATION.....

The Licensees stated that only Licensee Santino transports children at this time. Licensee Santino has a current and valid Driver License. Licensees understand 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. The facility has a current liability insurance from ALLSTATE.

Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Immunization, and Consent for Medical Treatment forms. Licensees files were reviewed, which includes required Training such as AB1207 and both Licensees Pediatric CPR and First Aid Certification expires on 07/2023. LPA informed Licensee that only the Influenza vaccination can be declined with a written, signed, and dated statement from the individual and the document will be maintain in the employee file.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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 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.

SEE 809 C.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
LIC809 (FAS) - (06/04)
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