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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412542
Report Date: 10/11/2022
Date Signed: 10/11/2022 12:23:59 PM


Document Has Been Signed on 10/11/2022 12:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:MENDOZA-MADRIGAL, CARMEN & RAFAELFACILITY NUMBER:
434412542
ADMINISTRATOR:CARMEN & RAFAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 793-4520
CITY:LOS GATOSSTATE: CAZIP CODE:
95033
CAPACITY:14CENSUS: 8DATE:
10/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Carmen & RafaelTIME COMPLETED:
12:35 PM
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On October 11th, 2022 at 8:30 am, Licensing Program Analyst (LPA) Kassandra Medrano conducted an annual required inspection which included a toured the home and yard, and a review of the required day-care forms with the licensee's Carmen and Rafael today. Present in the home are the two Licensee's, and 8 children. Capacity and ratio requirements of children were observed in compliance today. This type of home is a single family home. Adults living in the home are the two Licensee's. A review of records indicates that all adults working or living in the home who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. The day-care operates Monday-Friday, 7:30am-5:30pm. Licensee has daycare insurance through: Westchester.LPA observed the following: Day-care area is clean, orderly, and equipped with age-appropriate toys and equipment for the children. No baby walkers, bouncers, exercausers, etc. allowed to be used during day-care hours. Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. LPA observed there are no detergents, or cleaning products accessible to day-care children. Licensee stated that there is a body of water on property, LPA observed that water was properly barricaded and in an off limit area.Poisons are locked. Licensee states there are no guns or weapons of any kind in the home. The yard is fenced. Licensee’s CPR and First Aid both expire 08/21/2023. Emergency drills are conducted at least once every six months and properly logged. Licensee provides daily snacks and meals. Isolation of sick children reviewed/discussed, last drill conducted was 09/24/2022. Children’s roster was reviewed and is complete and up to date. Children and staff/helper files were reviewed and are complete. Supervision and transportation of children was discussed. Capacity options were reviewed. Licensee understands that care cannot be provided for more than the capacity as stated on the license.Requirements for reporting suspected child abuse was discussed, as well as reporting requirements for unusual incidences.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MENDOZA-MADRIGAL, CARMEN & RAFAEL
FACILITY NUMBER: 434412542
VISIT DATE: 10/11/2022
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All required postings are properly posted (License/Parent’s Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist) Licensee has updated immunizations. Licensee was reminded that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. Licensee was informed about the Provider Information Notices (PINs) on CCLD website. The licensees were reminded about Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or www.mandatedreporterca.com). LPA observed that the licensees have conducted the mandated reporter training via LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and
recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased
equipment. No deficiencies were issued today under Title 22 Division 12 of the California Code of
Regulations. This report and appeal rights were discussed with Licensee. This report must be available in the
facility for public review. Notice of Site Visit was given and must remain posted for 30 days. To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
Exit interview conducted and report was reviewed with the licensees, Rafael and Carmen.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
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