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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413549
Report Date: 06/11/2019
Date Signed: 06/11/2019 04:31:09 PM

COMPREHENSIVE INSPECTION
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:LARA, ANITAFACILITY NUMBER:
434413549
ADMINISTRATOR:LARA, ANITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 334-1138
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:14CENSUS: 7DATE:
06/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Anita Lara TIME COMPLETED:
04:40 PM
NARRATIVE
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On May 12, 2019 Licensing Program Analysts (LPAs) Stephanie Collins and Tuoc Doan conducted an annual inspection of the family day care home. LPAs met with Licensee, Anita Lara and explained the purpose of today's inspection. Upon LPAs’ arrival, Assistant Provider Samantha Villalobos was the only care provider present in the home with the six children. Samantha Villalobos has current Pediatric CPR/1ST Aid Certification, expiring 10/2020. Licensee returned home approximately two minutes after LPAs’ arrival with additional children.Thus, the home has seven children in care, of whom two were infant age.

Days and hours of operation are Monday through Friday from 07:30 AM – 5:30 PM. Licensee understands the capacity options and understands that the maximum capacity for a large family child care home is 14 children. Licensee stated that she understands that when there is only one care provider present, the home must comply with the capacity of a Small Family Child Care Home License, which has a maximum capacity of eight.

Licensee resides in the home with three of her own children who are under the age of 18 years. There are 3 adults residing in the home: Licensee, and Licensee’s Husband Francisco Haro and Daughter Phylisiti Lara. They all have Clearance for Criminal Background and Child Abuse Index Background Checks.
A review of staff records on 06/11/2019 show that Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
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 6
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: LARA, ANITA
FACILITY NUMBER: 434413549
VISIT DATE: 06/11/2019
NARRATIVE
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Licensee's Pediatric CPR and First Aid expires on 11/2019. Licensee has records showing proof of immunity against Measles and Pertussis. Licensee's AB1207 Mandated Reporter Training Certificate expires on 06/08/2020.

LPAs reviewed the roster of children in care and a copy was obtained. LPA reviewed the children's files. Records reviewed include Parents' Rights, immunization, Emergency Contact Information, and Consent for Emergency Medical Treatment form. The form LIC 282 "Affidavit Regarding Liability Insurance" were kept in the children's file.

LPAs inspected the indoor and outdoor areas of the home. Smoke and Carbon monoxide detectors were tested and proved to be functioning. Fire and disaster drills were last conducted and recorded on 04/16/2019. LPAs observed a fully charged fire extinguisher. The fireplace is screened. Medication, cleaning products and similar items that can pose a danger to children if readily accessible are stored inaccessible to children. Licensee states that there are no weapons in the home. Licensee has one small sized pet dog that is accessible to the day care children. Per Licensee, the dog is current with vaccination. The backyard is fenced, and the part used by children are enclosed by fencing. Licensee stated that the children do not use the backyard for outdoor activity until Licensee reorganizes and clean the outdoor play area and equipment. There were no bodies of water observed.

Licensee stated she does transport children. Licensee has a current and valid Driver License. Licensee understands that children cannot be left in parked vehicles unattended 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.

Licensee states that currently she is not providing Incidental Medical Services. 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.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: LARA, ANITA
FACILITY NUMBER: 434413549
VISIT DATE: 06/11/2019
NARRATIVE
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Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

Safe sleep information was reviewed with Licensee.

LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

Regulatory violations were observed during the inspection visit. Therefore, citations were issued. Exit Interview was conducted, where this report, the citations, plan of corrections, and appeal rights were discussed and reviewed with Licensee. A copy of this report was given to Licensee.



A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: LARA, ANITA
FACILITY NUMBER: 434413549
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2019
Section Cited
CCR
102421
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CHILD'S RECORD. The licensee shall maintain, in each child’s record, the signed and dated notice form LIC 995A, Parents Rights Notice, [...and] a copy of the emergency
This requirement is not met as evidenced by:
Based on LPAs' review of records, Child 1 was in care during the inspection, but
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Licensee Anita agrees to obtain the missing required records for Child 1 and send a copy to Licensing Office to show proof of correction by due date, 06/18/19.
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Licensee does not have any of the required records for Child 1. This poses a potential risk to the health and safety of children in care.
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Type B
06/18/2019
Section Cited
CCR
102418(g)
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IMMUNIZATION. Licensee shall document and maintain each child’s immunizations as long as the child is enrolled.
This requirement is not met as evidenced by:
Per LPAs' review of files, Licensee has not obtained Child 1's immunization record. This poses a potential risk to the health and safety
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Licensee Anita agrees to obtain Child 1's immunization record and send a copy to Licensing Office to show proof of correction by due date, 06/18/19.
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of children in care.
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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: LARA, ANITA
FACILITY NUMBER: 434413549
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2019
Section Cited
CCR
102417(g)
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Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: [...].
This requirement is not met as evidenced by:
Based on LPAs' inspection, LPA observed two
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Licensee Anita will cover the electrical outlet and send to Licensing Office pictures to show proof of correction by 06/18/2019.
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uncovered electrical outlets in the restroom used by children and within their reach, and one uncovered electrical outlet in the hallway.
This poses a potenal risk to the children in care.
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Type B
06/21/2019
Section Cited
CCR
102369(b)(9)
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Application for Initial License. Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.
This requirment is not met as evidenced by:
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Licensee Anita agrees to submit Proof of TB clearance for Phylisiti Lara and Samantha Villalobos by proof of correction due date, 06/21/19.
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Per LPAs' file review, Licensee's Adult daughter Phylisiti Lara is residing in the home but does not have proof of TB clearance. Assistant Provider Samantha Villaobos is present but also does not have proof of TB Clearance. This poses a potential risk for the children in care.
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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: LARA, ANITA
FACILITY NUMBER: 434413549
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2019
Section Cited
HSC
1597.622
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HEALTH & SAFETY CODE. Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. [...] The family day care home shall maintain documentation of the required immunizations.
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Licensee Anita agrees to submit to Licensing Office documented proof of immunization against Measles and Pertussis for Assistant Provider Samantha Villalobos by POC date 06/18/19.
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This requirement is not met as evidanced by: Per LPAs' review of staff records, Assistant Provider Samantha Villalobos does not have proof of immunity against measles or Pertussis during the inspection. This poses a potential risk to health and saftey of childern in care.
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Type B
06/18/2019
Section Cited
HSC
1596.8662(b)
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HEALTH & SAFETY CODE. [...] a person who, on January 1, 2018, is a licensed child care provider [...] shall complete the mandated reporter training provided [...] and shall complete renewal mandated reporter training every two years [...].
This requirement is not met as evidenced by:
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Per review of staff file and interview, Assistant Provider Samantha Villalobos has not completed the AB1207 Mandated Reporter Training. This poses a potential risk to the health and safety of children in care.
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Licensee Anita agrees to submit to Licensing OfficeAssistant Provider Samantha Villialobos' Certification of Completion for the Mandated Reporter Training by POC date, 06/18/19.
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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
LIC809 (FAS) - (06/04)
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