434410111-6-11-2019-07-CC-MSMS-BD2R4X-20190611124217

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410111
Report Date: 06/11/2019
Date Signed: 06/11/2019 12:42:25 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:	BARRENECHEA, MARIA		FACILITY NUMBER:	434410111
ADMINISTRATOR:	BARRENECHEA, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 242-0121
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94089
CAPACITY:	14	CENSUS: 11	DATE:	06/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Maria Barrenechea		TIME COMPLETED:	12:45 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) Mel Matos met with Maria Barrenechea, Licensee, for an unannounced annual/random inspection. LPA also observed two adult assistants and ten day care children (3 infants, 6 preschool, and Licensee's preschool age child) in the home during today's inspection. Days and hours of operation are Monday - Friday from 7:30 AM to 5:30 PM. The adults that reside in the home are the Licensee, Licensee's spouse, and two adult assistants. The Licensee's and two adult assistants certifications for CPR and First Aid are current and expire on September 15, 2020. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's visit. The last fire/disaster drill was completed on May 24, 2019. LPA reviewed twelve children's files during today's inspection. LPA observed updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each child's file. LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee 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 did not observe any wall heaters inside the home. Off limit areas in the home: master bedroom, master bathroom, office, one bedroom, one bathroom, one locked door & one locked drawer of the hallway bathroom vanity cabinet, furnace closet, kitchen, three locked cabinet doors, and attached garage. There are no stairs inside the home. Off limit areas outside the home: entire right half section of the backyard. LPA observed a fully charged 3A40BC fire extinguisher, working smoke & carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. All poisons are inaccessible to children. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 06/11/2019):

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019

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: BARRENECHEA, MARIA	FACILITY NUMBER: 434410111
	VISIT DATE: 06/11/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 06/11/2010):

A review of staff records on June 10, 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 also reminded the Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home at least 80% of the total operating hours of the day care and ensure that the children are supervised at all times. The Licensee understands her capacity options (includes Licensee's infant daughter) and she understands that she cannot have more than 14 children in the home at any time with at least two qualified assistants present. The Licensee states that she does not transport children.

No deficiencies issued during today's inspection.

LPA conducted an exit interview with the Licensee prior to the conclusion of today's inspection and the Licensee agreed to submit the following items to LPA by Friday June 21, 2019: 1) Copies of employee file for both adult assistants who reside in the home, 2) updated Application for a Family Child Care Home License (LIC 279), 3) updated Emergency Disaster Plan (LIC 610A), and copies of immunization record & proof of completion of the Mandated Reporter Training for child care workers for the Licensee.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019

LIC809 (FAS) - (06/04)

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