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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409243
Report Date: 12/06/2019
Date Signed: 12/06/2019 12:54:29 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:ONTIVEROS, MARIAFACILITY NUMBER:
434409243
ADMINISTRATOR:ONTIVEROS, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 613-6022
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:14CENSUS: 6DATE:
12/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Maria OntiverosTIME COMPLETED:
01:05 PM
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LPA Deanna Villagrana met with licensee Maria Ontiveros for an unannounced annual/random inspection. LPA explained the nature of today’s inspection to her. Present were licensee and licensee's adult daughter who is also her assistant and 6 day care children. Days and hours of operation are Monday to Sunday, 6:00am to 12:00am. Licensee states she will be closed 12/19/2019 through 01/06/2020. The adults that reside in the home are licensee, her husband, two adult daughters and occasionally her adult son with her 10 year old grand daughter.

A review of staff records on 12/05/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensee shall immediately remove the individual and prevents them from returning to the home or having contact with children in care.

LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPA observed a barricaded fireplace in the home. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items inside the home are stored inaccessible to children. LPA observed a fully charged 3A40BC fire extinguisher. LPA observed a working smoke detector and a working carbon monoxide detector. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: master bedroom/bath, 2 bedrooms and attached garage. There are no bodies of water. Backyard is fenced. Off limits outdoor: left and right side of home that is fenced off to children and a locked storage. There is a play structure that is used during summer and is fenced off and inaccessible to children unless licensee is present with children. Licensee states there are no animals in the home. LPA observed licensee and her daughter have current CPR and First Aid certification expiring 08/10/2021. Licensee completed Mandated Reporter training on 11/04/2017 and has not renewed because she stated it was difficult to complete in English and will complete when available in Spanish.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
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 2
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: ONTIVEROS, MARIA
FACILITY NUMBER: 434409243
VISIT DATE: 12/06/2019
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LPA observed a current roster of the children and a fire and disaster drill log which was last completed in 11/2019. LPA reviewed six children's files and observed all forms are completed and children have current immunization records. Licensee states day care is insured with DCI. LPA observed insurance expires 0715/2020. LPA discussed SB792 Immunization Requirements and observed licensee and her assistant have current immunizations against pertussis, measles and influenza.

Supervision of children was discussed with licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time. Licensee understands if she transports children via vehicle, children cannot be left in parked vehicles unattended at any time.

LPA discussed Zero Tolerance with $500 immediate civil penalty. An ongoing $100 per day per violation continues until the violation(s) is corrected. LPA discussed the requirements of AB633 to licensee and provided her the AB633 fact sheet and licensee understands the requirements. 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.

LPA reminded the Licensee that effective January 1, 2019 Assembly Bill 2370 requires that all licensed homes to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the Licensee. Safe sleep information & handout was also discussed with the Licensee. 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 SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
LIC809 (FAS) - (06/04)
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