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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413380
Report Date: 01/27/2022
Date Signed: 01/27/2022 04:25:05 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: 0DATE:
01/27/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Maria Fushiki TIME COMPLETED:
04:30 PM
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Licensing Program Analysts (LPAs) Aman Sharma and Mel Matos met with Licensee Maria Fushiki for unannounced Case Management inspection. LPAs were granted access to the home by the Licensee. Purpose of today's inspection: Licensee has requested to "activate" her license from inactive status. Licensee states she will be open Monday-Friday from 8:30 am to 5:30 pm. Adults that reside in the home are Ikko Fushiki, Licensees spouse, Licensee's three adult daughters Erika, Monica and Claudia and Claudia's spouse,Jose Patzan.

LPAs observed the required postings, including the facility license near the front entrance going into the daycare. Licensee has expired CPR and First Aid certifications (expiration: 02/15/2021), but will send LPA Sharma proof of completion. Licensee also has the required vaccines (MMR, Tdap, & flu) and is current with the Mandated Reporter Training for Child Care Workers (expiration: 3/2/2023).

LPAs discussed the safe sleep regulations with the 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. LPAs also informed the 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.


LPAs toured the indoor and outdoor areas of the home during today's inspection. LPAs observed sufficient materials, toys, and play equipment for the day care children. Licensee states that a child will be isolated in one of the rooms of the home, if necessary, due to illness or communicable disease. Pets in the home are one Chihuahua and two cats which are vaccinated. Licensee also has three guinea pigs that are kept caged. All pets are kept in the off-limits area of the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. There are no poisons inside the home.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
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 2
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: FUSHIKI, MARIA
FACILITY NUMBER: 434413380
VISIT DATE: 01/27/2022
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The home is clean and orderly, with central heating/air conditioning for safety & comfort. There are no open face heater units inside the home. Areas used for day care are: Dining Room, Family Room, and bathroom (located adjacent to the Family Room. The whole second floor (four bedrooms & 2 bathrooms) is off Limits to the children and LPAs observed a child safety gate installed at the base of the staircase to prevent access. Backyard is fenced and is used for outdoor activity. LPAs observed sufficient equipment and supplies for the children both indoors and outdoors. The left side of the backyard is off-limits. LPA observed the trampoline area in the right side area of the backyard is enclosed with fencing to keep it inaccessible to children. Licensee understands that the children shall be supervised at all times whenever using the trampoline. LPAs did not observe any bodies of water. A fully charged fire extinguisher (2A10BC) was observed in the home. Smoke and Carbon Monoxide Detectors were tested and proved to be functioning.

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.

Supervision of children was discussed with 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. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time without at least one qualified adult present. Licensee states that she does not transport any day care children. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.


Exit interview conducted and report was reviewed with the Licensee, Maria Fushiki. LPAs advised Licensee that her large Family Child Care Home will be activated upon completion and submission of current CPR/First Aid certifications for the Licensee.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
LIC809 (FAS) - (06/04)
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