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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409025
Report Date: 02/27/2020
Date Signed: 02/27/2020 02:13:56 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:RIOS, AMPAROFACILITY NUMBER:
434409025
ADMINISTRATOR:RIOS, AMPAROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 972-1077
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:14CENSUS: 4DATE:
02/27/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Rios, AmparoTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Almaraz, Araceli conducted an annual random inspection. LPA Almaraz met with Licensee, Rios, Amparo and explained the nature of today's inspection. Present during the inspection was the licensee and assistant Flores, Maria. There were four children present, preschool age. The hours of operation of the day-care are 5 AM to 11:30 PM, Monday through Friday. There are five adults residing in the home; Licensee, spouse, Rios, Jose,adult children Rios, Jose, Rios, Jessica and Rios Esmeralda.

Physical Plant: LPA Almaraz inspected the indoor and outdoor areas of the home today. Off limit areas in the home are as follows; Entire upstairs, gated and garage. Off limit areas outside the home are as follows: Backyard is temporarily off limits,there is a near by park . The front yard is safety complaint. Licensee states that there are weapons in the home, they are locked in safe, in garage, ammunition in separate locked safe. LPA did not observe any bodies of water inside or outside the home. Medication, cleaning products and similar items are stored inaccessible to children. Poisons are locked. Licensee has one pet, vaccinated. LPA observed a working smoke/carbon monoxide detector, 3A40BC fire extinguisher. LPA did not observe any heaters in the home. LPA Almaraz observed a barricaded fireplace.

Facility Records: Licensee Rios and assistant Flores have CPR and First Aid, which have an expiration date of 02/20/2021. LPA Almaraz observed that the Licensee and assistant have record of MMR & Tdap vaccinations, as well the flu vaccine. LPA observed a current roster, a current fire disaster/earthquake drills last log 12/02/2020. Licensee has day care insurance. Licensee completed Mandated Reporter Training 07/18/19, to be completed every two years.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
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: RIOS, AMPARO
FACILITY NUMBER: 434409025
VISIT DATE: 02/27/2020
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Assistant is waiting for Spanish edition but may try in English. LPA Almaraz reviewed two children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file.
Supervision of the children was discussed; Licensee Rios understands the following: A cleared adult must be present in the home during day care hours. The children must be supervised at all times. The capacity options and ratio requirements. Licensee understands not to leave children in the car unattended. The Licensee states that there is transporting of children currently.

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

A review of staff records on 02/25/2020 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates There are no deficiencies during today’s inspection.


LPA Almaraz conducted an exit interview and advised Licensee Rios of pending Department regulation update re: infant safe sleep. Please Refer to Department website: www.ccld.ca.gov for additional information. LPA discussed the requirements of AB633 to Licensee.

NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 DAYS. 2/2

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2