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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409291
Report Date: 05/04/2023
Date Signed: 05/04/2023 01:59:47 PM


Document Has Been Signed on 05/04/2023 01:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:GARCIA, JENNYFACILITY NUMBER:
434409291
ADMINISTRATOR:GARCIA, JENNYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 802-5520
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY:14CENSUS: 6DATE:
05/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Jenny GarciaTIME COMPLETED:
11:20 AM
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Licensing Program Analysts (LPA) Anna Morales conducted an unannounced Annual/Required Inspection. LPA met with Licensee, Jenny Garcia. Present in the home were Licensee, six day care children between the ages of 2-4 years old. Days and hours of operation are Monday - Friday from 6:30 AM -6:00 PM. Adults over the age of 18 and residing in the home are the Licensee, her spouse and her assistant. Licensee's two minor children (over the age of ten) also reside at the home. All adults have Criminal Background Check Clearances. LPA observed a current Children's roster. Last Disaster drill was conducted on 12/5/2022.

LPA toured the indoor and outdoor areas of the home during today's inspection: The home is a two story home. LPA observed barricaded stairs during today's inspection.
Off limit area inside the home (1st level): garage. Off limit areas inside the home: Entire second floor (master bedroom/bathroom, three additional bedrooms and an additional bathroom) and bedroom 2 on the first/ entry level. Off limit areas outside the home: The garage and fenced open area in the back yard. LPA observed a fully charged 3A40BC fire extinguisher, pull alarm and operational smoke and carbon monoxide detectors. Licensee stated that there are no firearms or other dangerous weapons in the home. Sharps, medications, detergents, and cleaning compounds are inaccessible to children.
The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children in the home. Furniture and equipment, such as mats, feeding chairs, and tables were age appropriate and in good condition. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters in the home. Page 1
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GARCIA, JENNY
FACILITY NUMBER: 434409291
VISIT DATE: 05/04/2023
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Licensee has two dogs however, they don't mingle with the children while in care. Licensee stated that she transports children and is aware that she is not allowed to leave the children without supervision at any time. Licensee stated only one child has an EPI Pen. LPA advised Licensee to obtain signature of parent of child for the form LIC922.

Licensee's and staff have current Mandated Reporter Training (AB1207). Licensee's expires on 6/6/2024. LPA discussed Senate Bill 792, Assembly Bill (AB1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with applicant Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

Licensee's and staff files were reviewed for the following records: Employee Rights (LIC9052), Criminal Record Statement (LIC508), Statement Acknowledging Requirement to report Child Abuse (LIC9108), and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza (or statement declining influenza). Licensee has a current First Aid/CPR on file and it expires on 2/5/2025

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 comes in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent

LPA discussed the requirements of AB 633 with the Licensee and understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GARCIA, JENNY
FACILITY NUMBER: 434409291
VISIT DATE: 05/04/2023
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Exit Interview was conducted with Licensee. No deficiencies were cited at today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.

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
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
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