434409633-10-5-2020-07-CC-DMAC-BU4LEY-20201005084217

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434409633
Report Date: 10/01/2020
Date Signed: 10/05/2020 08:42:24 AM

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:	CASTRO, KIM		FACILITY NUMBER:	434409633
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	10/01/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kim Castro, Licensee		TIME COMPLETED:	10:15 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	Licensing Program Analyst (LPA) Dung Mac conducted an announced case-management tele-inspection via video conference call (FaceTime) with Kim Castro, Licensee. Licensee submitted the application to the Department on July 3, 2020. A fire safety inspection request approval was received from the San Jose Fire Department on September 17, 2020. Days and hours of operation are Monday to Friday from 6:00AM to 10:00PM. LPA observed one school-age child and Licensee's minor daughter in the home during today's tele-inspection. The adults that reside in the home: Licensee and Licensee’s spouse (Ruben Castro). All individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances prior to today's tele-inspection. Licensee's CPR and First Aid certifications expired on 8/19/2020 and she is enrolled to renew her certifications on December 5, 2020. Proof of enrollment for both certifications is on file. Licensee’s Mandated Reporter Training expires 8/24/2022. Licensee's copies of immunization records are on file. Licensee owns the home and a copy of Control of Property is on file. Licensee does not have liability insurance and understands that if liability insurance is not carried, she will have the parents complete the Affidavit Regarding Liability Insurance (LIC 9182). Licensee states that she does not transport children at this time, but she understands that children cannot be left in parked vehicles unattended at any time. Licensee agreed to give LPA a tour of the home (indoor/outdoor) via FaceTime during today's tele-inspection.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020

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: CASTRO, KIM	FACILITY NUMBER: 434409633
	VISIT DATE: 10/01/2020

NARRATIVE

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The facility is a two-story house with barricaded stairs. The off-limit areas inside the home: living room, barricaded kitchen, back room, and the entire 2^nd floor. Main daycare area is in the converted garage. Licensee has a designated area in the home where a child(ren) can be isolated if exhibiting signs of illness. LPA observed the home is clean and orderly, with heating and ventilation for safety and comfort. LPA observed sufficient materials, toys, and play equipment for the day care children.

Licensees states that the home does not have any wall heaters. LPA observed a screened fireplace in the family room. LPA observed a fully charged 2A10BC fire extinguisher. LPA observed the home has working smoke/carbon monoxide detectors (tested by the Licensee during today's tele-inspection). Licensee states that there are no firearms in the home. Licensee has a first aid kit in the home, which also has a thermometer and sufficient emergency supplies.

LPA observed that detergents, cleaning products, medications, hazardous, sharp objects, and similar items that are dangerous to children in care were stored inaccessible, out of reach of children. Licensee states that all poisons are stored in a locked shed in the backyard. Licensee has three small-sized dogs that are kept away during day care hours.

LPA informed Licensee that smoking is prohibited in the home during daycare hours. Licensee understands and states that nobody smokes in the home. Licensee states that she does not have any baby walkers/inclined sleepers in the home and understands that baby walkers/inclined sleepers are not allowed in the home. Licensee states that she does not have any baby bouncers, jumpers, saucer chairs in the home.

LPA observed kitchen is gated on both ways. Sharp utensils in the kitchen are stored inaccessible to children. No lighter/matches or open bottles of alcohol were observed.

LPA observed toilet and faucet in both bathrooms are clean and operable. No medications, shampoos, mouthwash, perfumes, razors, cleaning products, air fresheners, and nail polish/remover were observed in the bathrooms.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020

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: CASTRO, KIM	FACILITY NUMBER: 434409633
	VISIT DATE: 10/01/2020

NARRATIVE

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Off limit areas outside the home: gated dog run and a locked shed. The backyard is fenced and is used for outdoor activity space. LPA observed locked gates on both sides of the home. There are no bodies of water observed. Licensee states that there are no thorn trees.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she does not have children who requires IMS at this time. Licensee was provided the information regarding ADA: toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: http://www.ada.gov/childqanda.htm.

A Family Child Care Home packet with updated Licensing forms, Self-Assessment Guide, “Lead Poisoning Facts Information" Flyer, and "Safe Sleep" Information were mailed to the Licensee prior to today's tele-inspection and Licensee acknowledged receipt of the packet.

Licensee was informed that due to the current Covid-19 pandemic and "Shelter In Place" Order, the Facility Evaluation Report will be emailed to Licensee (email: kim.kidscorner@gmail.com) with "Read Receipt" notification. Licensee understands that her reply to the email will serve as acknowledgement that the report was received.

LPA conducted an exit interview and advised Licensee that a large Family Child Care Home license will be approved upon receiving of Acknowledgement of "receipt" of today's report.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020

LIC809 (FAS) - (06/04)

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