434413574-1-16-2020-07-CC-DMAC-BKVPAV-20200116100923

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413574
Report Date: 01/16/2020
Date Signed: 01/16/2020 10:09:28 AM

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:	GUESS, RITA		FACILITY NUMBER:	434413574
ADMINISTRATOR:	GUESS, RITA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 272-5564
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95122
CAPACITY:	14	CENSUS:	DATE:	01/16/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:05 AM
MET WITH:	Rita Guess		TIME COMPLETED:	10:15 AM

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	Licensing Program Analyst, Dung Mac, and Licensing Program Manager, Diana Stephenson, met with the Licensee, Rita Guess, for an unannounced annual inspection. LPA observed there were no daycare children present during today's inspection. Days and hours of operation are: Monday-Friday 6:00am-6:00pm. Licensee stated she cares for school-age children. LPA toured the home both inside and out. Off-limit areas include all bedrooms, attached garage, and backyard. Licensee states that there are no weapons in the home. Detergents, cleaning products, medications, hazardous and other toxic materials are stored inaccessible to children. The last fire/disaster drill was conducted on 12/23/19. Facility has a small-sized dog. Licensee stated the dog is up-to-date vaccinated. LPA observed a fully charged fire extinguisher. Smoke and Carbon Monoxide detectors were tested and proved to be functioning. The home is clean, orderly, and safe for the day care children. LPA observed sufficient materials for the day care children. LPA observed that backyard is fenced and have the gates on both sides of the home. LPA observed no bodies of water. Licensee stated that she is transporting children. LPA reminded Licensee that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system. Licensee stated that she is taking the daycare children to Library, Hillview Park or Capital Park as outdoor activities. Licensee's file was reviewed. Licensee maintains records of Tuberculosis clearance, Measles and Pertussis immunization, and required training. Licensee declined to take flu shot. Licensee's Mandated Report training expires 12/8/21 and her Pediatric CPR & First Aid certification expires 10/2020. LPA reminded Licensee that the Mandated Reporter Training needs to be renewed every two years. Continued on Page #2

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

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: GUESS, RITA	FACILITY NUMBER: 434413574
	VISIT DATE: 01/16/2020

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Continued from Page #1

A review of records on 1/16/20 shows that all staff and other adults who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Adults who reside in the home are Licensee, Licensee's Spouse, and Licensee's Mother. They have Clearances for Tuberculosis, and Criminal Background and Child Abuse Index Checks. LPAs 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. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

Facility's Incidental Medical Services (IMS) policy was discussed. Licensee stated that she currently does not have any children in care who requires IMS. The following US Department of Justice resource was provided: http://www.ada.gov/childqanda.htm..

No citation was issued today. LPA conducted an exit interview where this report was reviewed with Licensee.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 DAYS.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

LIC809 (FAS) - (06/04)

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