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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408702
Report Date: 10/15/2019
Date Signed: 10/15/2019 04:59:44 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:MARDUENO, ARACELIFACILITY NUMBER:
434408702
ADMINISTRATOR:MARDUENO, ARACELIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 445-2958
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:14CENSUS: 9DATE:
10/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Araceli MarduenoTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Peter Tinkelenberg and Licensing Program Manager Diana Stephenson conducted an unannounced annual/random inspection. Licensee Araceli Mardueno greeted us at the front door and after disclosing the purpose of the visit, Licensee granted entrance at 2:05 PM. Licensee stated that 4 adults and 1 child live in the home. She is licensed for a large Family Child Care Home. LPA observed
3 infants, 3 preschool, and 3 school-age children in the home. Assistant Leticia Salvador was present to help care for the children. The facility is open Monday through Friday from 7 AM to 6 PM. .

At 2:15 PM LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. The LPA observed children’s toys, play equipment and materials that are safe and age appropriate. The home is kept clean and orderly and is properly heated and ventilated for the comfort of the day care children. There is no fireplace in the home and there are no stairs inside the home. The LPA observed no baby walkers or bouncers in the home. Off limit areas inside the home are: two bedrooms in the back of the home. LPA observed a fully charged 2A10BC fire extinguisher (last inspected 08/01/2019), a working smoke alarm and a working carbon monoxide detector. The Licensee states that she does not have any firearms in the home. LPA observed that poisons, detergents, and medicines are inaccessible to children. Outdoor play areas are fenced. As inspection was taking place during nap time, no children were observed playing in the back yard. Outdoor poisons were observed to be safely stored behind the fence on shelves, inaccessible to children.

LPA reviewed a current Child Care Facility Roster, which was complete. The LPA reviewed the Fire/Disaster drill log during today's inspection. The last fire drill was conducted on 09/26/2019; the last earthquake drill was conducted on 09/19/2019. The Licensee and assistant are exempt from Mandated Reporter training as English is not their primary language. Licensee's CPR and First Aid certification expire 10/06/2021. The LPA inspected the facility file and observed that Licensee and assistant have immunization documents
CONTINUED ON PAGE 2 DATED 10/15/2019
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Peter TinkelenbergTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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: MARDUENO, ARACELI
FACILITY NUMBER: 434408702
VISIT DATE: 10/15/2019
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CONTINUED FROM PAGE 1 DATED 10/15/2019
against measles and pertussis. Both License and assistant decline the flu vaccine. LPA reviewed 9 children's files and observed that the following children were missing documents: C-1, C-6, and C-9.

A review of staff records today indicate that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The Licensee does not administer any medication to the day care children at this time. Incidental Medical Services (IMS) policy was discussed. 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

For Provider Information and Quarterly Update: https://www.cdss.ca.gov/inforesources/community-care-licensing


Mandated Reporter training: www.mandatedreporterca.com

One Type B deficiency cited during today's inspection. Appeal Rights were presented and exit interview conducted.

A NOTICE OF SITE VISIT WAS PROVIDED AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Peter TinkelenbergTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
LIC809 (FAS) - (06/04)
Page: 2 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: MARDUENO, ARACELI
FACILITY NUMBER: 434408702
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2019
Section Cited

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102418(g)(1) Immunization. The licensee shall document … and shall maintain such documentation for as long as the child is enrolled. This requirement includes updating each child's PM 286 (6/95) …

This requirement was not met as evidenced by:
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Based on inspection of children's files, Licensee failed to maintain immunization documentation for C-1, C-6, and C-9 which poses a potential risk to the health and safety of the children in her 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: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Peter TinkelenbergTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:
DATE: 10/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2019
LIC809 (FAS) - (06/04)
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