434413713-7-1-2019-07-CC-EBEN-BDNNZP-20190701105441

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413713
Report Date: 12/20/2018
Date Signed: 07/01/2019 10:54:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	SAHAGUN, LAILA		FACILITY NUMBER:	434413713
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	12/20/2018
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Laila Sahagun		TIME COMPLETED:	12:40 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	Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Laila Sahagun for an unannounced annual/random inspection. LPA also observed Licensee's helper, Martha Marmol, 2 infants, 3 preschoolers and one school age child present during today's inspection. LPA notes that one of the infants present is Laila's son. Days and hours of operation are Monday - Friday from 7:00 AM to 6:00 PM. Laila states she is the only adult living in the home with her infant son. Licensee's CPR and First Aid certifications are current and expire on August 17, 2020. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Last fire/disaster drill was completed today 12/20/18. LPA observed that the Licensee and assistant, Martha Marmol have completed the required Mandated Reporter training. LPA inspected the entire home during today's inspection. Off limit areas in the home are garage, master bedroom and bathroom, deck and garage. Licensee requested to add a room that was previously off limits to children. LPA inspected the room. The walker used by her son was observed and removed and placed in off limit room. She understands that walkers and similar items are not allowed in family child care homes. The far gated area of the backyard is off limits. The storage shed, right side of yard and trampoline in the backyard are off limits. Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. The fire place in day care room (living room) is covered. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 12/20/2018):

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2018

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2018

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: SAHAGUN, LAILA	FACILITY NUMBER: 434413713
	VISIT DATE: 12/20/2018

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 12/20/2018):
LPA observed a fully charged 3A10BC fire extinguisher and working smoke/carbon monoxide detectors. The Licensee states that she does not have any weapons. Licensee has a pet dog. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.

A review of staff records on December 13, 2018 indicates that not all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee states that her boyfriend, Brett Blundell does not live in the home. He does not have criminal record approval and is not present during day care hours. LPA also reminded Laila 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.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 8 children in the home at any time. The Licensee states that she currently does not transport children. The Licensee states that she is currently not administering any medications to the day care children.

Laila and assistant have immunization's against pertussis, measles and influenza.

Website for provider resources & updates: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates
LPA conducted an exit interview in with the Licensee prior to the conclusion of today's inspection.
No deficiency cited.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2018

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2018

LIC809 (FAS) - (06/04)

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