434409935-6-27-2019-07-CC-JTSE-BDJW39-20190627165535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434409935
Report Date: 06/27/2019
Date Signed: 06/27/2019 04:55:49 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:	CASTRO, ANA		FACILITY NUMBER:	434409935
ADMINISTRATOR:	ANA CASTRO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 206-5251
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY:	14	CENSUS: 2	DATE:	06/27/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Ana Castro		TIME COMPLETED:	05:00 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	LPA Janet Tse met with licensee Ana Castro for an annual/random inspection. LPA explained the nature of today's inspection to Licensee. Present were two children including one infant with Licensee. Present in the home were also Licensee's adult son, her mother-in-law, and her 15-year-old child. Adults living in the home are Licensee, her husband, her mother-in-law, and her adult son, with a 15-year-old child. Days and hours of operation are Monday to Friday, 7:00am to 5:30pm. LPA toured the indoor and outdoor of the home. LPA observed a glass door covered fireplace and no wall heaters. Off limits indoor: the main house except for a bathroom to be used by the day care children. The main house consists of a master bedroom, master bathroom, three bedrooms, laundry area, dining room, living room, and a kitchen. LPA observed no bodies of water. Licensee stated there is no firearms/weapons in the home. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children. Backyard is fenced. LPA observed a locked storage shed in the backyard. Off limits outdoor: the detached office unit, the fenced area next to the office unit, the front area of the right side yard, and the back area of the left side yard. LPA observed a covered patio with posts, electrical wiring and lights has been built in the play area, and Licensing was not notified prior to the construction. LPA reminded licensee that she can only have 14 children according to her license. LPA observed a granny unit attached to the hone with a different address: 4817 Alum Rock Ave., San Jose, CA 95127. The granny unit has a separate entrance; and is fenced off from the child care home. Fire extinguisher is size 3A40BC and filled. Smoke and carbon monoxide detectors are operable. 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. Telephone is in working order. Children were supervised on the visit and LPA went over substitute options. LPA also discussed if Licensee transports children, they are never to be left in parked vehicles. Facility Evaluation Report dated 06/27/2019 to be continued on next page:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019

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: CASTRO, ANA	FACILITY NUMBER: 434409935
	VISIT DATE: 06/27/2019

NARRATIVE

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Facility Evaluation Report dated 06/27/2019 to be continued from previous page:

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 06/25/2019 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions.

LPA obtained a copy of the current roster of the children. LPA reviewed three children's files. LPA observed that in each child’s record has a copy of the emergency information card that contains all of the information specified by regulation. LPA observed that Licensee has current Pediatric CPR/1^st Aid expiring 05/18/2021.

Licensee was given a list of the current forms for childcare. Website to download forms and to review Licensing regulations: http://ccld.ca.gov. LPA discussed the immediate civil penalties for Zero Tolerance of $500, and an ongoing $100 per day per violation continues until the violation(s) is corrected. LPA discussed the Healthy Beverage Act and AB633 requirements for type A violation. SB 792 Immunization Requirements was discussed. LPA observed the required immunization records for Licensee are in file. Incidental Medical Services were discussed with the licensee. The licensee is not providing IMS (Incidental Medical Services) at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care. Information regarding Safe Sleep Practice and Lead Poisoning were provided to Licensee.

Licensee's primary language is Spanish. LPA advised Licensee of the Mandated Reporter AB1207 Compliant Child Care Training. Website to complete training: https://mandatedreporterca.com.

Deficiency was cited. Notice of site visit was issued and must be posted for 30 days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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, ANA	FACILITY NUMBER: 434409935
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/27/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/02/2019 Section Cited CCR 102416.3(c)(4)	1 2 3 4 5 6 7	Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Construction of exterior decks or porches. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee shall forward an updated facility sketch, both indoor and outdoor, to LPA by 07/02/2019 due date. Fire clearance will be ordered upon receipt of the facility sketch.
	8 9 10 11 12 13 14	LPA observed a covered patio with posts, electrical wiring and lights has been built in the play area, and Licensing was not notified prior to the construction. This poses a potential risk to the Health, Safety, or Personal Rights of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019

LIC809 (FAS) - (06/04)

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