434410116-1-26-2023-07-CC-SCOS-CNFQBS-20230126110202

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410116
Report Date: 01/25/2023
Date Signed: 01/26/2023 11:02:13 AM

Document Has Been Signed on 01/26/2023 11:02 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CASTRENCE, JUANITA		FACILITY NUMBER:	434410116
ADMINISTRATOR:	CASTRENCE, JUANITA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 259-3147
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95133
CAPACITY:	14	CENSUS: 5	DATE:	01/25/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Juanit Castrence		TIME COMPLETED:	05:11 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	Page 1 Licensing Program Analysts (LPA) , Stephanie Collins, and conducted an unannounced Annual inspection of the Preschool. LPA met with licensee Juanita Castrence and informed her the purpose of the visit. LPA arrived at 2:15 PM, LPA observed required posting posted in a prominent publicly accessible area at the facility. Operating days and hours are Monday-Sunday 06:00 AM to 05:30 AM. Upon entry into facility a total 5 children including 1 infant were observed in attendance . Licensee was reminded that all adults 18 and over, 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 Child Care Center. 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. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Last fire/disaster drill was completed on 10/2022. At 2:25 LPA reviewed ( 4) four Children files and one infant file and Licensee's file review. File review included LIC 282 Affidavit Regarding Liability insurance , Immunization, LIC 700 Identification and Emergency information LIC 627 Concent for Emergency Medical Treatment, LIC 995 Notification of Parents Rights Staff file review included: Mandated Reported Certification and CPR/First Aid Card.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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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Document Has Been Signed on 01/26/2023 11:02 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CASTRENCE, JUANITA	FACILITY NUMBER: 434410116
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on (record review)], the licensee did not comply with the section cited above in [count] out Licensee Juanita Castrence which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/27/2023
	Plan of Correction
1 2 3 4	Licensee agrees to submit current proof Mandated Reporter on or before POC date

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based record review, the licensee did not comply with the section cited above in [1] out of [3] Licensee which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/27/2023
	Plan of Correction
1 2 3 4	Licensee agrees to submit proof of CPR/First Aid by an approved EMSA trainer. by or before POC DATE

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: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

Document Has Been Signed on 01/26/2023 11:02 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CASTRENCE, JUANITA	FACILITY NUMBER: 434410116
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in [1] out of [1] [(objects) C1,C2,C3,] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/27/2023
	Plan of Correction
1 2 3 4	Licensee agreed to submit proof of Immunization for C1, C2, C3 on or before POC Date

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on (record review)], the licensee did not comply with the section cited above in [1] out of [1 ] for C3, ] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/27/2023
	Plan of Correction
1 2 3 4	Licensee agrees to submit proof of immunization for C1 by POC date or before

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: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CASTRENCE, JUANITA	FACILITY NUMBER: 434410116
	VISIT DATE: 01/25/2023

NARRATIVE

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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 in the home. Furniture and equipment, such as cribs, mats, feeding chairs, and tables were age appropriate and in good condition. LPA did not observe any wall heaters or fireplace units inside the home. Off limit areas in the home are: All 4 bedrooms, master bathroom and attached garage. There are no stairs inside the home. Off limit area in back yard; back yard is fully fenced in, however the back yard is off limits at this time due to re-construction.

LPA observed a fully charged 3A40BC fire extinguisher, working smoke / carbon monoxide detectors, and no bodies of water. The Licensee states that she does not have any weapons in the home.

Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. LPA observed that food storage areas were clean, free of litter, rubbish, and rodents/vermin. Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on.

Drinking water is arranged to be readily available to children.

This facility provides Incidental Medical Services – currently the facility does not have any children in care who requires IMS. 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.
Safe Sleep ( when applicable)

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CASTRENCE, JUANITA	FACILITY NUMBER: 434410116
	VISIT DATE: 01/25/2023

NARRATIVE

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LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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

LPA reviewed with licensee the violations that would result in an immediate $500 civil penalty assessment. Director is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: ccld.ca.gov] to access resources for Providers, Regulations etc.

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.

In the areas that were evaluated, regulatory violations were observed at the time of the inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Juanita Castrence

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC809 (FAS) - (06/04)

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