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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412108
Report Date: 12/19/2019
Date Signed: 12/19/2019 08:52:09 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:SORIA, MARIA, GUZMAN PEREZ, SAMUEL & BOLANOS, JAVIFACILITY NUMBER:
434412108
ADMINISTRATOR:SORIA, MARIA, GUZMAN PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 347-0732
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:14CENSUS: 14DATE:
12/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Maria Soria TIME COMPLETED:
05:38 PM
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On December 19 2019 Licensing Program Analysts (LPA) Stephanie Collins conducted an annual inspection of the family day care home. LPA met with Licensee, Maria Soria and explained the purpose of today's inspection. Upon LPA’s arrival, Assistant Paloma Paat, Licensee’s son Javier Bolanos and 12yr old daughter were present in the home with 14 children in care . Maria Soria has current Pediatric CPR/1ST Aid Certification, expiring 02/2021. Days and hours of operation are Monday through Friday from 06:00 AM – 6;00 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 one child who is under the age of 18 years and five adults; the Licensee’s Husband (Samuel Guzman) Their sons Javier Bolanos, Christian Bolanos, and her mother Aurora Alcazar .
A review of staff records on 012/05/2019 show that 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 has records showing proof of immunity against Measles and Pertussis. Licensee's AB1207 Mandated Reporter Training Certificate expires 02/19/2021. Assistant Paloma Paat has immunization against measles and influenza. Paloma’s Mandated Reporter Training expires 2/15/21.

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

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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: SORIA, MARIA, GUZMAN PEREZ, SAMUEL & BOLANOS, JAVI
FACILITY NUMBER: 434412108
VISIT DATE: 12/19/2019
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LPA inspected the indoor and outdoor areas of the home. Smoke and Carbon monoxide detectors were tested and proved to be functioning. Off limit areas in home are the main parts of house, two bedrooms and garage. There is a hall bathroom used for emergencies only The fireplace in living room is screened. The day-care is located in the back area of the home with its own bathroom. A fully fenced back yard was observed. No open bodies of water observed. Fire and disaster drills were last conducted and recorded on 11/27/2019. 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. 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.

No regulatory violations were observed during the inspection visit. Exit Interview was conducted, . 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: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
LIC809 (FAS) - (06/04)
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