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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413421
Report Date: 03/06/2020
Date Signed: 03/06/2020 01:01:49 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:MORA, YOLANDAFACILITY NUMBER:
434413421
ADMINISTRATOR:MORA, YOLANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 705-3870
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:14CENSUS: 10DATE:
03/06/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Mora, YolandaTIME COMPLETED:
01:01 PM
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Licensing Program Analyst (LPA) Almaraz, Araceli conducted a 1 Year Required inspection. LPA Almaraz met with Licensee, Mora, Yolanda and explained the nature of today's inspection. Present during the inspection was the licensee, assistants Mora, Katelyn and Arjona, Marissa. There were ten children present, including four infants and six preschool age. The hours of operation of the day-care are 7AM to 6PM, Monday through Friday. There are four adults residing in the home; Licensee, spouse, Mora, Hector, assistant, mother in law, Mora, Maria and two minor children.

Physical Plant: LPA Almaraz inspected the indoor and outdoor areas of the home today. Off limit areas in the home are as follows; Master bathroom and garage . Off limit areas outside the home are as follows: Right side, gated. The front yard is safety compliant and backyard is fully fenced. Licensee states that there are no weapons in the home. LPA did not observe any bodies of water inside or outside the home. Medication, cleaning products and similar items are stored inaccessible to children. Poisons are locked. Licensee has no pets. Licensee has a working smoke/carbon monoxide detector, 2A10BC fire extinguisher. LPA did not observe any heaters in the home. LPA observed a there is no fireplace.

Facility Records: LPA Almaraz observed the following: Licensee Mora and assistant have CPR and First Aid, which have an expiration date of 07/13/2021. Licensee and assistants have record of MMR & Tdap vaccinations. Licensee opted out form for the flu vaccine; assistants have flu vaccine. A current roster, a current fire disaster/earthquake drills last log 11/22/2019.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
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 3
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: MORA, YOLANDA
FACILITY NUMBER: 434413421
VISIT DATE: 03/06/2020
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Licensee has no day care insurance. Licensee and assistant completed Mandated Reporter Training on 08/06/2019, licensee understands training is to be completed every two years.
LPA Almaraz reviewed ten children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file.
Supervision of the children was discussed; Licensee Mora understands the following: A cleared adult must be present in the home during day care hours. Children must be supervised at all times. The capacity options and ratio requirements. Not to leave children in the car unattended. The Licensee states that there is no transporting of children currently.

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

A review of staff records on 03/05/2020 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.



Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

There are no deficiencies during today’s inspection.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: MORA, YOLANDA
FACILITY NUMBER: 434413421
VISIT DATE: 03/06/2020
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LPA Almaraz conducted an exit interview with the Licensee and advised the licensee of the pending Department regulation update re: safe sleep for infant children. LPA Almaraz referred the Licensee to the Department website: www.ccld.ca.gov for additional information. LPA discussed the requirements of AB633 to Licensee.

For a list of recalled products please visit www.safekids.org


NOTICE OF SITE VISIT WAS ISSUED, MUST BE POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3