434409960-12-24-2019-07-CC-EBEN-BK6RDV-20191224115631

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434409960
Report Date: 12/23/2019
Date Signed: 12/24/2019 11:56:47 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:	GARCIA, SILVIA		FACILITY NUMBER:	434409960
ADMINISTRATOR:	SILVIA GARCIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 225-4080
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95121
CAPACITY:	14	CENSUS: 1	DATE:	12/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Silvia Garcia		TIME COMPLETED:	04:00 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	Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Silvia Garcia and conducted an annual random inspection. Also present during the inspection was one day care child and Licensee's assistant, Evelia Ornelas. Licensee's hours of operation are Monday - Friday 6:00 AM to 6:00 PM. Silvia states there are five adults living in the home; Licensee, her husband (Leonardo Garcia) daughters (Janet Garcia), (Denise Garcia) and her sister in law (Evelia Ornelas). Licensee has a 16 year old daughter who lives in the home. All adults living in the home have TB test. A review of staff records on December 20, 2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reviewed Licensee and Assistants file. Assistant (Evelia Ornelas) has immunization against pertussis and measles, has LIC 508, LIC 9052, LIC 9108, and TB test. CPR & first Aid expires 06/2021. Licensee, Silvia completed the Mandated Reporter Training on 01/05/2018. Her assistant is Spanish speaking and has not completed the course. Silvia has current CPR & First Aid expiring on 04/2020. Silvia Garcia has immunization against pertussis and measles. LPA reviewed one child file and observed the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in file. Child is school age and does not have immunization records on file. Licensee uses the affidavit regarding liability insurance. LPA observed a current facility roster and obtained a copy. LPA reviewed fire disaster drill log; last practiced drill was conducted on 05/15/19. LPA reminded Silvia that the drill is to be conducted once every six months and advised her that she can do it monthly. Licensee states that there are no weapons in the home.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2019

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: GARCIA, SILVIA	FACILITY NUMBER: 434409960
	VISIT DATE: 12/23/2019

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LPA inspected the indoor and outdoor areas of the home during today's inspection. Off limit areas in the home are three bedrooms and garage. Off limit areas outside are storage shed and fenced of portions of backyard. Storage shed is locked. Licensee has a working telephone in the home and provided LPA with her cell number (408) 806-7205- Licensee provided LPA with her email address garciasylvia69@icloud.com.

LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA observed a covered fire place. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. All poisons are inaccessible to children.

LPA discussed Lead Safety Information (AB 2370). Chapter 676, statues of 2018, requires all child care providers, upon enrolling or re-enrolling any child, to provide the parent or guardian with written information. LPA provided Licensee with, Effects of Lead exposure flyer to handout to parents.

Safe Sleep was discussed: place infants on their backs when sleeping, use a firm sleep surface such as a mattress in a safety approved crib, keep soft bedding such as blankets, pillows, toys out baby's sleep area and ensure that pacifiers have nothing attached to them. LPA emailed Licensee link to access information.

LPA discussed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, etc.

Exit Interview was conducted. A copy of this report was provided to the Licensee at the conclusion of the inspection.
NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

No deficiency cited.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2019

LIC809 (FAS) - (06/04)

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