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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413380
Report Date: 09/19/2019
Date Signed: 09/19/2019 12:51:31 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:FUSHIKI, MARIAFACILITY NUMBER:
434413380
ADMINISTRATOR:FUSHIKI, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 390-3435
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:14CENSUS: 9DATE:
09/19/2019
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Maria FushikiTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Tuoc Doan conducted an unannounced Case Management inspection of the family day care home for the purpose of ensuring that Licensee is adhering to the Compliance Plan that Licensee agreed to implement as the result of the Non-Compliance Conference held at the San Jose Child Care Regional Office on 05/16/2019. LPA met with Licensee Maria Fushiki. The two day care rooms were inspected and records were reviewed. LPA observed that Licensee kept in each child's file a signed form LIC 9224 Acknowledgement of Receipt of Licensing Reports for reports issued on 02/06/19 and 05/16/19.

Upon entry into the home, LPA observed present were nine children in care, of whom four were infant age. Licensee was present with two Assistant Providers, Irma Bastidas and Rosa Gomez. They have Clearances for Criminal Background Check and Child Abuse Index Check. 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. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

Child Car Seat Law was reviewed with Licensee. Licensee stated that the day care does not provide transportation to children in care, but Licensee understands that if they do, person driving the children need to have a current and valid driver license, children cannot be left unattended in parked vehicles 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.

In the areas that were evaluated, no regulatory violations were observed at the time of the visit. Exit Interview was conducted, where this report was reviewed with Licensee.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
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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