434411856-6-23-2021-07-CC-SYIP-C49VXK-20210623164940

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434411856
Report Date: 06/23/2021
Date Signed: 06/23/2021 04:49:44 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:	CONTRERAS, LINDA		FACILITY NUMBER:	434411856
ADMINISTRATOR:	CONTRERAS, LINDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 710-9777
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 10	DATE:	06/23/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:41 AM
MET WITH:	Linda Contreras		TIME COMPLETED:	11:30 AM

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) Samantha Yip conducted an unannounced Required 1 Year inspection. LPA met with Licensee Linda Contreras and explained the reason for the inspection. Present during today's inspection were Licensee, her mother, who helps with the daycare children, and 10 children. Two of whom were infant age. All adults present have cleared fingerprint clearance. There is board to post required posting. The hours of operation are Monday through Friday 7AM to 5PM. There is working phone in the home. LPA toured the home. The off-limit areas of the home the kitchen, laundry room, hallway closet, garage, the entire upstairs, and the backyard. There are stairs and a fireplace in the home which are barricaded. The home was observed to be clean. Furniture and equipment were observed to be in good condition. LPA observed that there is sufficient amount of toys for children in care. Cleaning supplies, disinfectants, and other items that could pose a risk to children was observed to be inaccessible. LPA reminded Licensee that all disinfectant wipes need to be out of reach of children. There were no baby walkers observed during today's inspection. LPA discussed with Licensee about the safe sleep regulation and documentation of any infants sleeping. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 06/03/2021. Licensee stated that there are no weapons, such as firearms, stored in the home. The front yard and the side front yard are used, which is fenced. All play equipment and toys were observed to be in good condition. There is pool in the backyard, which has a fence around it. There were no other bodies of water observed during today's inspection. ------------------CONTINUES ON 809 DATED 06/23/2021 PAGE 2-------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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: CONTRERAS, LINDA	FACILITY NUMBER: 434411856
	VISIT DATE: 06/23/2021

NARRATIVE

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------------------CONTINUATION OF 809 DATED 06/23/2021 PAGE 1--------------------------

Licensee stated that she does not transport children at this time, but understands that children cannot be left alone and unattended in parked vehicles. Licensee also stated that she does not provide Incident Medical Services (IMS).

A copy of the facility roster was obtained. 10 children's file were reviewed. The records reviewed include, but not limited to Identification Contact Card.

Licensee and her Assistant's files were also reviewed. The records reviewed include but not limited to CPR/1st Aid card and Mandated Reporter Training. Licensee has a valid CPR/1st Aid, which expires on 05/2022. Licensee and her assistant both completed the Mandated Reporter Training on 12/18/2019. LPA reminded Licensee that the Mandated Reporter Training requires renewal every 2 years. Licensee and her Assistant have immunization record for measles and pertussis on file. LPA reminded Licensee to sign and date decline of influenza.

The adults living in the home are Licensee, her spouse, and her adult daughter. All adults have cleared criminal record, child abuse index clearance, and TB test. Licensee stated that she will submit the LIC 508 for her daughter to Licensing. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, 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.

Licensee will submit the following to Licensing:
- LIC 508 for her daughter
- updated LIC 999A: facility sketch
- LIC 279: Application form

In the areas that were evaluated during today's inspection, no deficiencies were cited. An exit interview was conducted where this report was discussed and provided to Licensee. A Notice of Site Visit has been issued and must be posted for 30 days.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

LIC809 (FAS) - (06/04)

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