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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412087
Report Date: 10/29/2019
Date Signed: 10/30/2019 05:08:41 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:MORENO, VANESSAFACILITY NUMBER:
434412087
ADMINISTRATOR:MORENO, VANESSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 705-3812
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:14CENSUS: 3DATE:
10/29/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Moreno VanessaTIME COMPLETED:
04:55 PM
NARRATIVE
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On October 29, 2019 Licensing Program Analysts (LPA) Stephanie Collins conducted an annual inspection of the family day care home. LPA met with Licensee, Vanessa Moreno and explained the purpose of today's inspection. Upon LPA arrival Vanessa’s mother (Esperanza Moreno), her daughter (Yamilete Lopez ) with Three (3) children in care.

Days and hours of operation are Monday through Friday from 06:00 AM – 5:30 PM. Licensee understands the capacity options and understands that the maximum capacity for a large family child care home is 14 children. Licensee stated that she understands that when there is only one care provider present, the home must comply with the capacity of a Small Family Child Care Home License, which has a maximum capacity of eight.

Licensee resides in the home with 5 of her own children of which 4 are under the age of 18 years. There are 3 adults residing in the home: The Licensee, Licensee’s Husband (Juan Ibarra) and Daughter (Yamilete Lopez). A review of staff records on 10/28/2019 show that Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded 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.

Licensee's Pediatric CPR and First Aid expires on 04/20/2020. Licensee has records showing proof of immunity against Measles and Pertussis.


SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
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 3
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: MORENO, VANESSA
FACILITY NUMBER: 434412087
VISIT DATE: 10/29/2019
NARRATIVE
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LPA reviewed the roster of children in care and a copy was obtained. LPA reviewed the children's files. Records reviewed include Parents' Rights, immunization, Emergency Contact Information, and Consent for Emergency Medical Treatment form. The form LIC 282 "Affidavit Regarding Liability Insurance" were kept in the children's file.
LPA inspected the indoor and outdoor areas of the home. Smoke and Carbon monoxide detectors were observed and proved to be functioning. Fire and disaster drills were last conducted and recorded on 09/2019. LPA observed a fully charged fire extinguisher. Medication, cleaning products and similar items that can pose a danger to children if readily accessible are stored inaccessible to children. Licensee states that there are no weapons in the home. Licensee has one pet dog that is not accessible to the day care children(Kept outdoors stays in the gated side yard) . The backyard is fully fenced, Per Licensee backyard is currently off limits due to re-organization effort. There were no bodies of water observed.
Licensee stated she does transport children. Licensee has a current and valid Driver License. Licensee understands that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children in care shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.
Licensee states that currently she is not providing Incidental Medical Services. 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.
Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. Safe sleep information was reviewed with Licensee.

LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

Regulatory violations were observed during the inspection visit. Therefore, citations were issued. Exit Interview was conducted, where this report, the citations, plan of corrections, and appeal rights were discussed and reviewed with Licensee. A copy of this report was given to Licensee.



A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: MORENO, VANESSA
FACILITY NUMBER: 434412087
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2019
Section Cited

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HEALTH & SAFETY CODE. Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. [...] The family day care home shall maintain documentation of the required immunization's.
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This requirement is not met as evidenced by:
LPA's file review of records for Mother Esperanza Moreno proof of immunized against Measles and Pertussis was not availible for review during the inspection. This poses a potential risk to the health and safety of children in care.
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Type B
11/08/2019
Section Cited

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MANDATED REPORTER TRAINING. [...] a person who, on January 1, 2018, is a licensed child care provider [...] shall complete the mandated reporter training provided [...] and shall complete renewal mandated reporter training every two years [...].
This requirement is not met as evidenced by:
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LPA's review of files .Licensee stated that she was not aware of the above requirement. Mandated Reporter Training. This poses a potential risk to children's health and safety of children in care.
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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2019
LIC809 (FAS) - (06/04)
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