434413549-2-24-2020-07-CC-SCOS-BM544W-20200224174702

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413549
Report Date: 02/24/2020
Date Signed: 02/24/2020 05:47:09 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:	LARA, ANITA		FACILITY NUMBER:	434413549
ADMINISTRATOR:	LARA, ANITA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 334-1138
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY:	14	CENSUS: 6	DATE:	02/24/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Lara, Anita		TIME COMPLETED:	03:30 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	On February 24, 2020 Licensing Program Analysts (LPA) Stephanie Collins conducted an annual inspection of the family day care home. LPA met with Licensee’s Samantha Jazmin and explained the purpose of today's inspection. Upon LPA’s arrival, Assistant Provider Samantha Jazmin was the only care provider present in the home with the six children. Samantha has current Pediatric CPR/1ST Aid Certification, expiring 10/2020. Licensee returned home approximately 15 minutes after LPA’s arrival . Days and hours of operation are Monday through Friday from 07:30 AM – 5:30 PM. Licensee’s Assistant Samantha 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 two of her own children who are under the age of 18 years. There are 4 adults residing in the home: Licensee, Licensee’s Husband Francisco Haro and Daughter Phylisiti Lara.They all have Clearance for Criminal Background and Child Abuse Index Background Checks. Licensee A review of staff records on 2/24/2020 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 Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2020

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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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: 02/24/2020

NARRATIVE

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Licensee's Pediatric CPR and First Aid expires on 10/2022. Licensee has records showing proof of immunity against Measles and Pertussis. Licensee's AB1207 Mandated Reporter Training Certificate expires on 06/08/2020.
LPA reviewed the roster of children in care and a copy was obtained. LPA reviewed the Same of 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.
LPA 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 . LPA 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. 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.
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. No 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 Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2020

LIC809 (FAS) - (06/04)

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