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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411274
Report Date: 10/05/2021
Date Signed: 10/05/2021 03:21:49 PM

COMPREHENSIVE INSPECTION
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:ROSAS, MIRIAM & TERRON, MARCOS & NUNEZ, MONICAFACILITY NUMBER:
434411274
ADMINISTRATOR:ROSAS, TERRON, & NUNEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 401-2943
CITY:SAN JOSESTATE: CAZIP CODE:
95133
CAPACITY:14CENSUS: 6DATE:
10/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Miriam Rosas and Monica NunezTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensees Miriam Rosas and Monica Nunez for a required one year visit. LPA explained the nature of today’s inspection to her. Present were licensee's Miriam and Monica with 6 day care children. Days and hours of operation are Monday to Friday, 6:00am to 6:30pm. The adults that reside in the home are licensee and her husband. Daughter Monica and her husband recently moved out. LPA informed Miriam that Monica can no longer be on the license and requested an updated application.

A review of staff records on 09/20/2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensees understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensees shall immediately remove the individual and prevents them from returning to the home or having contact with children in care.

LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPA did not observe stairs or a fireplace in the home. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items inside the home are stored inaccessible to children. LPA observed a fully charged 3A40BC fire extinguisher. LPA observed a working smoke detector and a working carbon monoxide detector. Licensees states there are no weapons/firearms in the home. Off limit areas indoor: one bedroom and one bathroom that is also a laundry room. Licensee Miriam requested to use a room previously noted as off limits. LPA reviewed back bedroom to the left and observed room is safe for children. LPA granted use of the room and requested an updated sketch of the facility. There are no bodies of water. Backyard is fenced. Off limits outdoor: detached garage and right side of home that is fenced off to children which includes two locked storages. Licensee Miriam states there are no animals
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ROSAS, MIRIAM & TERRON, MARCOS & NUNEZ, MONICA
FACILITY NUMBER: 434411274
VISIT DATE: 10/05/2021
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in the home. LPA observed all licensees have a current CPR and First Aid certification. Miriam and Marcos expires on 09/17/2022. Licensee's have completed Mandated Reporter training.

LPA observed a current roster of the children and a fire and disaster drill log which was last completed on 09/15/2021. LPA reviewed six children's files and observed all forms are completed and children have current immunization records. LPA observed day care is insured with DCI and expires on 05/04/2022. LPA discussed SB792 Immunization Requirements and observed all licensees have immunization records on file.



Supervision of children was discussed with licensees and they understands that they must be present in the home during day care hours and ensure that the children are supervised at all times. Licensees understand their capacity options and they understand that they cannot have more than 14 children in the home at any time. Licensees understands if they transports children via vehicle, children cannot be left in parked vehicles unattended at any time.

Safe sleep update: LPA discussed the new “Safe Sleep” regulations with the Licensees including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensee. LPA reminded the Licensees that infants up to 12 months of age must sleep on their backs, and all infants shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.

LPA discussed Zero Tolerance related regulations with licensee Miriam Rosas and Monica Nunez and was advised of the assessment of $500 immediate civil penalty and an ongoing $100 per day per violation continues until the violation(s) is corrected. Incidental Medical Services were discussed with the licensees. The licensees are not providing IMS (Incidental Medical Services) at this time. Licensees will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

No deficiency was cited.

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

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
LIC809 (FAS) - (06/04)
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