434409405-10-2-2019-07-CC-MMAR-BGKVDA-20191002162025

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434409405
Report Date: 10/02/2019
Date Signed: 10/02/2019 04:20:32 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:	ESQUIVEL, CARMEN		FACILITY NUMBER:	434409405
ADMINISTRATOR:	ESQUIVEL, CARMEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 531-0209
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95121
CAPACITY:	14	CENSUS: 10	DATE:	10/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Carmen Esquivel		TIME COMPLETED:	04:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/02/19 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Annual/Random Inspection at Carmen Esquivel's Family Day Care Home. LPA met with Licensee, Carmen and explained the purpose of today’s inspection. Present in the home were Licensee, Assistant Helper and 10 day care children including her 5 year old grandson (1 infant, 4 preschoolers and 5 school age). Facility is in compliance with required ratios today. Children were napping and later engaged in various activities under the supervision of the Licensee and Assistant Helper. 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, Licensee's spouse, two sons and one daughter. Licensee's minor grandson also lives in the home. All adults have Criminal Background Check Clearances, TB clearance and signed Criminal Record Statements LIC508 on file with Licensing Office. LPA toured the indoor and outdoor areas of the home during today's inspection: INDOOR SPACE: In Use Areas: Living Room, Kitchen, Play Room, Bathroom downstairs Off Limit Areas: Entire second floor (stairs gated), Attached Garage 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. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Furniture and equipment, such as cribs, mats, feeding chairs, and tables were age appropriate and in good condition. There were no baby walkers or bouncers observed on the premise during today’s inspection. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters in the home. There is barricaded fireplace inside the home. There are barricaded stairs inside the home. There is a water filled fish tank with pet turtles in the Play Room which is covered and kept at a higher level and out of reach from children. OUTDOOR SPACE: In Use Areas: Front lawn converted into Play yard, Backyard converted into covered Play area. Off limit: Storage Shed (locked) The outdoor space and play equipment were observed to be maintained in safe condition and free of hazards. Heavy structure was secured to the ground. The yards are fenced and there were no bodies of water outside. Continued on Page #2. Report dated 10/02/19

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

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: ESQUIVEL, CARMEN	FACILITY NUMBER: 434409405
	VISIT DATE: 10/02/2019

NARRATIVE

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LPA observed a fully charged 2A10BC fire extinguisher in the Play Room and working smoke / carbon monoxide detectors. The Licensee states that she does not have any weapons. LPA reviewed a current Children Roster and Fire/Disaster Drill Log during today's inspection. Last fire/disaster drill was completed on 09/28/19. All required postings including but not limited to Parent Rights Poster, Facility License, Emergency Disaster Plan were observed posted on a wall in the Play Room. The Licensee states that she does transport children. She is aware that children cannot be left alone in parked vehicles. Licensee states that she supplies snacks and meals to the children. Food storage area was observed to be clean and child cups, bowls and bottles were labeled with child’s name. LPA discussed Healthy Beverages Act with the Licensee. Day care home appeared to be free of flies, other insects, and rodents during today’s inspection.

FILE REVIEW:
10 Children's files were reviewed and contained all required Licensing forms and records including but not limited to Receipt for Parents' Rights, Immunization record, Identification & Emergency Information, Consent for Medical Treatment, Parent Notification for Additional Children in Care, Affidavit Regarding Liability Insurance, Health History.
Licensee and Assistant files contained Criminal Record and Child Abuse Index Clearance, TB clearance, Statement Acknowledging Requirement to Report Suspected Child Abuse, Employee Rights, Immunizations for Measles, Pertussis, Flu and required Mandated Reporter Training per AB1207. Licensee's certifications for CPR and First Aid are current and expire on 04/08/2020.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during 80% of the operating hours of the day care and ensure that the children are supervised at all times. The Licensee understands her capacity options and that she cannot have more than 14 children in the home at any time with at least two qualified adults present. Licensee also understands that she must comply with the ratio and capacity requirements of the Small Family Child Care Home license whenever she or a qualified adult is alone with the children.

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 violation within a 12-month period.
Continued on Page #3. Report dated 10/02/19

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

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: ESQUIVEL, CARMEN	FACILITY NUMBER: 434409405
	VISIT DATE: 10/02/2019

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. The Licensee stated that she currently does not have any children in care who requires IMS. 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.

Beginning January 1, 2019 AB 2370 requires licensed homes and centers 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 facility.

Website links for free subscription to Quarterly Updates Newsletter:
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates
or
Send email to: childcareadvocatesprogram@dss.ca.gov

In the areas that were evaluated, no regulatory violations were observed. Exit Interview was conducted, where this report was reviewed and discussed with Licensee. Licensee signed the report acknowledging receipt of documents.

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

END OF REPORT

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

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