434409589-8-29-2023-07-CC-FRAA-CV6M34-20230829091430

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434409589
Report Date: 08/28/2023
Date Signed: 08/29/2023 09:14:37 AM

Document Has Been Signed on 08/29/2023 09:14 AM - 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:	MENDOZA, MICHELLE & STEVEN		FACILITY NUMBER:	434409589
ADMINISTRATOR:	MENDOZA, M & S		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 274-6181
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 13	CENSUS: 10	DATE:	08/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Michelle and Steven Medoza		TIME COMPLETED:	11:45 AM

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 08/28/2023, at 8:40am, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced 1- year annual inspection. LPA was granted access to the home by Licensee, Steven Mendoza and explained the nature of today’s inspection. Present in the home were licensee, co-licensee/spouse, Michelle Mendoza, assistant, Virginia Quicho and 10 children including 1 infant and 9 preschool age. Licensees are operating within the ratio and capacity requirements of the license. Days and hours of operation are Monday to Friday, 7:00 am to 6:00 pm. LPA observed all required posted materials near the front entrance to the home. The entrance for the daycare is to the left of the main entrance which opens into the bonus room/ sun room. There is a waiver for a fountain in the front yard but licensee stated that they removed the fountain. The adults that reside in the home are licensees, licensee's parents and one adult child. Licensee has three minor children residing in the home. LPA toured the indoor and outdoor areas of the home during today's inspection. Licensees have a working telephone in the home (408-274-6181). LPA observed sufficient materials, toys, and play equipment for the day care children. Furniture, such as tables, chairs, diaper changing table, feeding chairs and shelves, are in good condition. The floors were free of tripping hazards with toys put away in bins/shelves. The home has central heating/cooling and ventilation for comfort of children. The home is single story. Off limit areas inside the home: master bedroom, three bedrooms, three bathrooms, office and attached garage. LPA observed a barricaded fireplace in the living room. Children play in the fenced off play area outdoors. The outdoor space and play equipment were observed to be age appropriate and free of hazards. LPA observed resilient material under swings and high climbing structures. There are no bodies of water observed. LPA observed the bathroom used by children in the bonus room was in operating condition. Toilets and faucet are clean and operable. LPA observed a fully charged 2A10BC fire extinguisher in the kitchen area and working smoke/carbon Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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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Document Has Been Signed on 08/29/2023 09:14 AM - It Cannot Be Edited

Created By: Farida Raja On 08/28/2023 at 10:52 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: MENDOZA, MICHELLE & STEVEN	FACILITY NUMBER: 434409589
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above for 2 out of 3 staff which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/11/2023
	Plan of Correction
1 2 3 4	Licensee, Michelle Mendoza, and staff will complete the Mandated Reporter training and submit certificate of completion to LPA by Plan of Correction date of 09/11/2023.

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 1 infant child which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/11/2023
	Plan of Correction
1 2 3 4	Licensees will conduct 15-minute sleep checks on one infant in care and submit proof of completed check to LPA by Plan of Correction date of 09/11/2023.

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:

Gladys Kuizon

LICENSING EVALUATOR NAME:

Farida Raja

LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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: MENDOZA, MICHELLE & STEVEN	FACILITY NUMBER: 434409589
	VISIT DATE: 08/28/2023

NARRATIVE

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monoxide detectors. Licensee stated that she does not have any weapons or pets in the home. All detergents, cleaning compounds, poisons, medications, sharp objects and other similar items were observed to be stored inaccessible to children. Licensees understand that smoking is prohibited in the home.

Drinking water is readily available for children in the home via individual water bottles. Licensees state that they provide breakfast, lunch, dinner and snacks to the children in care. Licensees understand that any food brought from home shall be labeled with each child's name and properly stored or refrigerated. Licensee states that a child will be isolated in the family room if necessary due to illness or communicable disease.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was last conducted on 07/13/2023. LPA obtained copy of children's roster.

Children file review was completed and found to be current and up to date. Ten (10) children’s files were reviewed during today's inspection. Licensees carry daycare insurance and LPA observed a current policy verifying valid coverage. LPA reviewed one infant's file and did not observe the 15-minute sleep log.

LPA discussed the safe sleep regulations with licensees, and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA provided licensees with a copy of an Individual Infant Sleeping Plan (LIC 9227) for infants 12 months and under and a sample 15- minute sleeping infant check form for children under 2 years of age. LPA also informed licensees of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA reviewed three (3) staff files (Licensees and assistant) for the required forms. LPA confirmed through file review that the CPR/First Aid Training was up to date for each staff member present at the time of the inspection, and that all staff members were associated with the facility in Guardian and that all staff present had passed criminal background checks. Licensees and staff have the required immunization in file for

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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: MENDOZA, MICHELLE & STEVEN	FACILITY NUMBER: 434409589
	VISIT DATE: 08/28/2023

NARRATIVE

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measles, pertussis and influenza. Licensee, Michelle Mendoza and assistant did not have a current Mandated Reporter Training. Licensee understands the training is mandatory to all licensees and adults in the home in contact will children and requires renewal every two years. LPA referred the licensees to the training website: www.mandatedreporterca.com for additional information on the online training.

Licensees were reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Supervision of children was discussed with Licensees, and they understand that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensees understand their capacity options and understands that they cannot have more than 14 children in the home at any time and a qualified assistant must be present. Licensee understands in absence of an assistant the license capacity is reduced to 8 and ratio (age of the children) must be observed.

LPA discussed "zero tolerance" related regulations which includes the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

Licensees are encouraged to visit the Department’s website at https://cdss.ca.gov/inforesources/child-care-licensing to access general updates, resources for providers, regulations, adoptions of new laws, pay annual fees etc.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication:

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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: MENDOZA, MICHELLE & STEVEN	FACILITY NUMBER: 434409589
	VISIT DATE: 08/28/2023

NARRATIVE

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Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Licensees stated that they transport children. LPA reminded Licensees that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.
Licensees were informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensees, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Two Type B deficiencies were cited today on the attached LIC 809D page. Appeal rights were printed and provided to Licensees. LPA reminded Licensees that failure to correct deficiencies by Plan of Correction Due Date may result in penalties of $100 per day per violation.

Exit interview conducted and report was reviewed with the licensee, Michelle Mendoza.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC809 (FAS) - (06/04)

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