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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409704
Report Date: 05/11/2022
Date Signed: 05/11/2022 12:46:05 PM

Document Has Been Signed on 05/11/2022 12:46 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:GARCIA, ELIZABETHFACILITY NUMBER:
434409704
ADMINISTRATOR:GARCIA, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 445-2369
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
05/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Elizabeth GarciaTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Ofelia Calivo met with Licensee Elizabeth Garcia for an unannounced Required - 1 Year Inspection. Also present in the home were Licensee's helper, Eduardo Garcia and 12 daycare children. LPA was granted access to the home by the Licensee and toured both indoor and outdoor areas during the inspection. LPA observed all required posted materials. Days and hours of operation for the facility are Monday through Friday from 8:00 AM to 5:00 PM. There are no active waivers or exceptions for this facility. Licensee states that she’s the only adult living in the home with her 16-year-old son.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.


The Licensee has a working telephone and the number is (408) 445-2369. The home is safe, healthful, and comfortable with age-appropriate toys, play equipment, and materials for the day care children. There are no stairs in the home and no fire place. Off limit area inside the home is the attached garage. The garage is used as a passageway to the backyard. Fencing separates the supplies in the garage from the passageway. The home has a fully charged 3A40BC fire extinguisher. The home has working smoke/carbon monoxide detectors. The Licensee states that she does not have any pets, firearms, or weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. The Licensee states that she does not administer any medication to the day care children at this time.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Ofelia Calivo
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2022
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: GARCIA, ELIZABETH
FACILITY NUMBER: 434409704
VISIT DATE: 05/11/2022
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The backyard is fenced. There were no bodies of water observed and the open area of the back yard has toys with room for children to play. The swing set is anchored to the ground and the plastic house is sturdy. The ground is covered with artificial turf. Insecticides, herbicides, and garden tools are inaccessible.

LPA reviewed and obtained a copy of facility roster (LIC 9040). Fire/disaster drill was conducted on February 2, 2022. Twelve children’s files were reviewed during today’s inspection for the following records: Notification of Parents Rights (LIC 995A), Consent for Emergency Medical Treatment (LIC 627), Identification and Emergency Information (LIC 700), and Immunization Records. Licensee does not carry daycare insurance.

LPA reviewed Licensee and one helper’s files for the following records: Criminal Record Statement (LIC 508), Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), Employee Rights (LIC 9052), Immunization in measles, pertussis and flu, and Mandated Reporter Training. Licensee has Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and declination for flu. The Licensee has Mandated Reporter Training that expires on August 18, 2022. Licensee's CPR/First-Aid expires on February 2, 2024. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years.

LPA discussed the safe sleep regulations with the Licensee 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 also informed Licensee 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.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Ofelia Calivo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
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: GARCIA, ELIZABETH
FACILITY NUMBER: 434409704
VISIT DATE: 05/11/2022
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Incidental Medical Services (IMS) policy was discussed. 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

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/process.


Exit interview conducted and report was reviewed with the Licensee Elizabeth Garcia.

There are no deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Ofelia Calivo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
LIC809 (FAS) - (06/04)
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