434412530-10-9-2019-07-CC-SCRL-BGSV52-20191009160713

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412530
Report Date: 10/09/2019
Date Signed: 10/09/2019 04:07:18 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:	LAFOSSE, MILAGROS		FACILITY NUMBER:	434412530
ADMINISTRATOR:	LAFOSSE, MILAGROS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 266-2524
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95124
CAPACITY:	14	CENSUS: 11	DATE:	10/09/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Milagros Lafosse		TIME COMPLETED:	04:15 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	Licensing Program Analyst (LPA) Stephanie Rangel conducted an unannounced annual/random inspection to the home today. LPA met with Milagros Lafosse, Licensee and explained the nature of today's inspection to her. LPA also observed Licensee's spouse, 13 year old son and 11 day care children including 2 infants and 9 preschool age children in the home during today's inspection. Days and hours of operation are Monday - Friday from 7:30 AM to 6:00 PM. The adults that reside in the home: Licensee and her spouse. Licensee's certifications for CPR and First Aid are current and expired in September 24, 2021. LPA reviewed the Child Care Facility Roster and the Fire/Disaster drill log during today's inspection. Last fire/disaster drill was completed on October 7, 2019. 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. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters inside the home. Off limit area inside the facility are the entire second floor, 2 bedrooms downstairs, and the garage, there is a gate to barricade the stairs to the second floor. Licensee is wanting to change the 2 bedrooms downstairs to on limits. Rooms appear clean and safe. Home will submit updated fire sketch. Off limit area outside the facility is a narrow back yard which is inaccessible to children by a gate. LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. A review of staff records on 10/7/19 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 10/09/2019):

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C Rangel	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019

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: LAFOSSE, MILAGROS	FACILITY NUMBER: 434412530
	VISIT DATE: 10/09/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 10/09/2019):

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time. The Licensee states that she does not transport children via vehicle; however, she understands that children cannot be left in parked vehicles unattended at any time.

LPA conducted an exit interview with the Licensee and spouse prior to the conclusion of today's inspection and advised the Licensee of "mandated reporter" training that all Licensees and staff are required to complete as of January 1, 2018. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information on the online training. Proof of completion of Mandated Report Training was viewed during today's inspection for Licensee and helper.

LPA also advised the Licensee of the immunization requirement (pertussis, measles, and flu vaccines) for all Licensees and staff that work directly with the children. Proof of immunization's for Milagros and spouse were viewed during today's inspection.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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

Periodic information releases accessible by signing up at: www.myccl.ca.gov

Effect of Lead Exposure handout dated 1/20/19 given during today’s inspection. Licensee understands that per Assembly Bill (AB 2370), written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C Rangel	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019

LIC809 (FAS) - (06/04)

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