434413156-6-2-2022-07-CC-SYIP-CEZNRZ-20220602104223

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413156
Report Date: 06/01/2022
Date Signed: 06/02/2022 10:42:31 AM

Document Has Been Signed on 06/02/2022 10:42 AM - It Cannot Be Edited

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:	MADRIGAL, SANDRA		FACILITY NUMBER:	434413156
ADMINISTRATOR:	MADRIGAL, SANDRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 767-2343
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 12	DATE:	06/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:19 PM
MET WITH:	Sandra Madrigal		TIME COMPLETED:	03:35 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) Samantha Yip conducted an unannounced Required 1 Year inspection. LPA met with Licensee Sandra Madrigal and explained the reason for the inspection. Upon arrival of today's inspection, there were 10 children, whom 4 were infant age. Licensee, her assistant, and her adult son, who helps with the daycare were also present. All adults present have cleared fingerprints. 4 school-age children arrived shortly after. 3 children left prior to school-age children arriving. LPA toured the inside and outside of the home. The off-limit areas of the home are bathroom in bedroom and the garage. There is a fireplace in the home, which is barricaded. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible to children. Toys and equipment were observed to age appropriate and in good condition. There were no baby walkers observed during today's inspection. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Licensee stated that there are no weapons, such as firearms, stored in the home. The backyard is used and is fenced. There is pool in the backyard, which has a fence around it. LPA observed that there a couple of panels that are starting to go down and the latch that connects the panels together is broken. The fence does not fall over if pushed on. LPA observed that area where the fence is starting to go down is not five feet high. Licensee stated that she will have someone come to fix the fence and send proof to Licensing. Licensee place a zip-tie to tie the panel together during today's inspection. There were no other bodies of water observed during today's inspection. All equipment and play structure were observed to be age-appropriate. ---------------------------continues on 809 dated 06/01/2022 page 2---------------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022

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 4

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: MADRIGAL, SANDRA	FACILITY NUMBER: 434413156
	VISIT DATE: 06/01/2022

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
26
27
28
29
30
31
32

-------------------------continuation of 809 dated 06/01/2022 page 1---------------------------------

LPA reviewed 15 minute sleep check. All infants have their own individual crib or play yard. There were no loose articles in the crib. LPA discussed with Licensee about ensuring that Section D on LIC 9227: Individual Sleeping Plan is filled out. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/chil
d-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.

Licensee stated that she does not have children who require Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. Plan for Providing IMS is on file. 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

Licensee does transport children and understands that children cannot be left alone and unattended.

A copy of the facility roster was obtained during today's inspection. 10 children's files were reviewed during today's inspection. The records reviewed include but not limited to immunization records and parent's rights.

Licensee and her assistants files were reviewed during today's inspection. The records reviewed include but not limited to Mandated Reporter training. Licensee and her assistant

-------------------------continues on 809 dated 06/01/2022 page 3----------------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: MADRIGAL, SANDRA	FACILITY NUMBER: 434413156
	VISIT DATE: 06/01/2022

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
26
27
28
29
30
31
32

-------------------------continuation of 809 dated 06/01/2022 page 2------------------------------

completed the Mandated Reporter training. Licensee and S-1's completed training on 01/21/2022 and S-2 completed training on 05/21/2021. Licensee and her assistants have a valid CPR/1st Aid, which expires on 05/15/2023. Immunization records for measles and pertussis are on file. LPA reminded Licensee that all forms, such as LIC 9108 and employee rights are filled out and in their file.

The adults 18 and over living in the home are Licensee, her spouse, and her adult son. Licensee has two minor children. All adults have cleared fingerprints and TB clearance. 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.

As a result of this inspection, one Type B citation was issued. Exit interview conducted and report was reviewed with the licensee Sandra Madrigal. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 06/02/2022 10:42 AM - It Cannot Be Edited

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: MADRIGAL, SANDRA	FACILITY NUMBER: 434413156
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(5)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence. (A)Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. LPA observed that there were four panels of the fence that were starting to come down and was not straight. Those areas are not five feet high, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/17/2022
	Plan of Correction
1 2 3 4	Licensee stated that she will have call the fencing company to have them fix the panels and send proof to Licensing.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4