434410047-1-22-2020-07-CC-SRED-BL42NP-20200122163306

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410047
Report Date: 01/22/2020
Date Signed: 01/22/2020 04:33:10 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:	MELENDEZ, MICHELLE		FACILITY NUMBER:	434410047
ADMINISTRATOR:	MELENDEZ, MICHELLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 567-9353
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95054
CAPACITY:	14	CENSUS: 10	DATE:	01/22/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Michelle Melendez		TIME COMPLETED:	04:40 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) Shannel Reed met with Michelle Melendez, Licensee, for an unannounced annual/random inspection. LPA also observed Licensee with her spouse, Anderson Melendez, assisting with the day care children and her mother in law, Maria Melendez, who’s fingerprint clearances are pending. Present today were 10 daycare children (one (1) infant, seven (7) preschool aged and two (2) school aged, whom are the Licensee’s minor children). Also in the home during today's inspection is the Licensee’s Mother. The adults that reside in the home are the Licensee and her spouse with their two minor children (occasionally the Licensee’s adult sons come to stay when home from college) and the Licensee’s mother. The home does not have any stairs. Days and hours of operation are Monday - Friday from 7:00 AM to 6:00 PM. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire drill was conducted 12/16/19. LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee’s has a working telephone in the home. 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 barricaded fireplace in the home. Off limit areas inside Licensee's home: Master bedroom& bathroom, bedrooms 1 and 2 and the detached garage. Off limit areas outside the home: left side yard and one locked shed in the left side yard. LPA review the Licensee’s and Assistant’s file information. The Licensee's certifications for CPR and First Aid are current and expire 12/14/21. LPA observed that the Licensee’s Assistants also have current CPR /First Aid certifications. LPA observed the required Immunization’s against Measles, Pertussis and/or Influenza opt out statement and the Mandated Reporter Training Certificate on file for the Licensee and her staff. LPA reviewed the six (6) enrolled children’s files. All files have the required documentation and immunization's. REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 01/21/20):

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

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: MELENDEZ, MICHELLE	FACILITY NUMBER: 434410047
	VISIT DATE: 01/22/2020

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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 01/21/20):
LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee’s states that they do not have any weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. The Licensee states that she does not administer medication to children other than her own minor child.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options. The Licensee states that she does not transport children.

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.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov.

No Title 22 deficiencies were cited during today’s inspection.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

LIC809 (FAS) - (06/04)

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