434409633-10-12-2022-07-CC-AALZ-CK5QDJ-20221012120451

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434409633
Report Date: 10/12/2022
Date Signed: 10/12/2022 12:06:00 PM

Document Has Been Signed on 10/12/2022 12:06 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CASTRO, KIM		FACILITY NUMBER:	434409633
ADMINISTRATOR:	CASTRO, KIM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 600-8280
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	14	CENSUS: 1	DATE:	10/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Castro, Kim		TIME COMPLETED:	12:33 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 this day Licensing Program Analysts (LPA/s) Almaraz conducted an annual random inspection. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA/s met with Licensee, Castro, Kim and explained the nature of today's inspection. Present during the inspection was the licensee and one infant. Licensee states that there are currently 10 children enrolled in the large Family Child Home Day Care. There was one child present. The hours of operation of the day-care are 5 AM to 10 PM Monday through Saturday. There are two adults residing in the home (criminal record clearances on file). Licensee, Spouse Castro, Ruben. Physical Plant: This is a two story dwelling which consists 4 bedrooms and 4 lavatories. LPA/s inspected the indoor and outdoor areas of the home today. Per licensee off limit areas in the home are as follows: Upstairs, front dinning room, kitchen, laundry room, Made inaccessible with gates. Off limit areas outside the home are as follows: Shed, locked. The backyard is fully fenced. The front yard is safety complaint. The children use the back yard. During this inspection, the following was noted: At 9:15 AM, LPA/s began tour through the interior of the home. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating for safety and comfort. There were safe toys, play equipment and materials observed for children. LPA/s did not observe any hazards inside of the home. There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The licensee states that there are no firearms, poisons in the home. The licensee does understand that poison must be locked with a key or combination lock. Licensee states that there are no weapons in the home. LPA did not observe any bodies of water inside or outside the home. Licensee has 2 pet/s, vaccinated. 1/4

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

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: 10/12/2022

NARRATIVE

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LPA/s observed and inspected sleeping equipment for infants. LPA/s observed one cribs for the infant in care who is unable to climb out of the play yard. All equipment meets the US Consumer Product Safety Commission safety standards. Please see www.safekid.org for a list of any recalled products. LPA/s observed that crib/s are free from loose articles and objects. There are no objects hanging above or attached to the side of the cribs. LPAs observed that play yards do not hinder the entrance or exit to and from the space they are sleeping in. Mattresses were observed to be firm and covered with a fitted sheet that is appropriate to the mattress size. Each infant has their individual bedding and is washed weekly as required. Soiled bedding is replaced when wet or soiled and is placed in an area inaccessible to infants. Pacifiers were observed to not be attached to anything. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping.

Facility Records: Licensee has the following: 1. CPR and First Aid, valid until 02/13/23. MMR & Tdap vaccinations, as well as and flu vaccine. 3. A current roster. 4. Licensee stated there is homeowner’s insurance. 5. Mandated Reporter Training, valid until 08/24/22, licensee will take it 10/15/22 and send to LPA via email. Licensee understands this must be renewed every two years. Licensee understands failure to submit this may result a case management and a deficiency. Please go to www.mandatedreporterca.com

LPA/s issued the Children’s Record Review (LIC 857) and the Review of Staff records (LIC 859) to the Licensee during this inspection. LPA/s reviewed one children's file/s and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file.

Incidental Medical Services (IMS) policy was discussed. Per Licensee there are currently no children enrolled who required 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. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
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SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: 10/12/2022

NARRATIVE

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Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained. A review of PIN 20-24-CCP Recently approved Safe Sleep Regulations in Effect was discuss and a copy was provided to the Licensee during this inspection.

Fire and Disaster Safety: LPA/s observed a working smoke/carbon monoxide detector, 2A40BC fire extinguisher, purchased within one year. LPA did not observe any heaters in the home. LPA Almaraz observed a screened fireplace. Fire disaster/earthquake drills last log 10/12/22.

Supervision: Supervision of the children was observed; Licensee understands the following: A cleared adult must be present in the home during day care hours. The children must be supervised at all times. The capacity options and ratio requirements. Licensee understands not to leave children in the car unattended. The Licensee states that there is transporting of children currently.

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee.

The following was discussed:
· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearance prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
· The Licensee shall be present in the home and shall ensure that children are supervised at all times.
· Children shall not be left in park vehicles.
· The capacity specified on the license shall be the maximum number of children for whom care can be provided.
· Car seats shall only be used for transportation purposes and shall not be used for sleeping. 3/4

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4

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: 10/12/2022

NARRATIVE

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All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
· When a child shows signs of illness, they will be separated from other children until the nature if the illness is determined.
· Personal rights must be accorded to the children in care.
· Reporting requirements.

LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children’s records requirements, mandated child abuse and injury/death reporting, and criminal record transfer requirements were discussed.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

At this time, there were no deficiencies cited during today’s inspection.

A notice of site visit was issued and must remain posted for 30 consecutive days.

Exit interview conducted and report was reviewed with facility representative,

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SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC809 (FAS) - (06/04)

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