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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413549
Report Date: 10/27/2023
Date Signed: 11/06/2023 09:28:04 AM


Document Has Been Signed on 11/06/2023 09:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:LARA, ANITAFACILITY NUMBER:
434413549
ADMINISTRATOR:LARA, ANITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
4083341138
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:14CENSUS: 3DATE:
10/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Anita LaraTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sheena Chin met with Licensee, Anita Lara, for an unannounced annual inspection. LPA explained the nature of today’s inspection to Licensee. Present during today’s inspection were the licensee, her helper (daughter), and 3 kids in care in the facility. Days and hours of operation are Monday to Friday, 7:30am to 5:30pm. The adults that reside in the home are licensee, her husband and her son. The licensee owns the home.

Observation
LPA observed that required postings were posted. LPA, along with the licensee toured the inside and outside of the home. The facility has a full charged fire extinguisher, 2A10BC. The Carbon monoxide/smoke detector in the hallway is working properly. The off-limit areas inside in the home are all the three bedrooms and garage. All disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible. LPA observed that there are toys for children and each water bottle had a label of a child’s name. LPA observed that the fence between the living room and the kitchen was broken and might fall, posing a potential risk to children in care. The licensee stated that she'll fix the fence and send a picture to LPA. It's unnecessary to have fence between the two areas as children can come to the living room and kitchen. But the licensee, Anita Lara, stated that she preferred to divide the two areas with the fence because she does not want kids running around in the facility.
LPA conducted CARE Tools for this annual inspection, which include Physical Plant, Care and Supervision, Facility Administration, Records, Staffing Ratio and Capacity, Personnel Rights for compliance with all licensing statutes, regulations, and interim licensing Standards, and results were documented on the tool.

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SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena ChinTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023
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 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LARA, ANITA
FACILITY NUMBER: 434413549
VISIT DATE: 10/27/2023
NARRATIVE
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Records review
The Licensee & her helper have current CPR and First Aid certifications expiring Jan/2024. The Licensee and the helper both have child abuse training certificate, expiring 1/24/2025. LPA reviewed the fire and disaster drills log which is to be done at least once every six months. The last drills were conducted on 2/16 / 2023.
LPA reviewed all 9 children files. Immunization records are maintained and updated in form. LPA observed Notification of Parents’ Rights is in each child’s file. The licensee only has one child under 12 month old and 15 min. sleeping check log was maintained but it was not clear enough to show the checks. LPA provided a sample of sleeping log to the licensee. However, the licensee did not have a sleeping plan for the 5-month old infant.
During today’s inspection, all adults present or residing in the home have criminal record clearances required by the Department. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Discussion


Supervision of children was discussed with Licensee, who 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. Licensee states that she transports children (one in middle school, 2 in elementary) via vehicle and that she understands that children cannot be left in parked vehicles unattended at any time. The licensee has valid driver's license.


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SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena ChinTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LARA, ANITA
FACILITY NUMBER: 434413549
VISIT DATE: 10/27/2023
NARRATIVE
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Discussions
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed 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.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.
The Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Deficiency
Regulatory violations were observed during the inspection. Therefore, citations were issued.

Further questions
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena ChinTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LARA, ANITA
FACILITY NUMBER: 434413549
VISIT DATE: 10/27/2023
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Exit
During the exit interview, the Licensee, Anita Lara, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
A notice of site visit was given and must remain posted for 30 days.
Exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were reviewed and discussed with Licensee.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena ChinTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 11/06/2023 09:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: LARA, ANITA
FACILITY NUMBER: 434413549

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the record review, the licensee did not comply with the section cited above. The licensee didn't have a fire drill within 6 months, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2023
Plan of Correction
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The licensee stated that the facility will have a fire drill this afternoon when all the children are in the facility. The licensee will send LPA a photo of the fire log.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. The licensee did not maintain a sleeping plan for the 5-month infant, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2023
Plan of Correction
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The licensee will work with the parnets to finish the sleeping plan, LIC9227. The licensee will send the finished sleeping plan to LPA.
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: Gladys KuizonTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena ChinTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5