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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413713
Report Date: 08/21/2019
Date Signed: 09/12/2019 02:38:10 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:SAHAGUN, LAILAFACILITY NUMBER:
434413713
ADMINISTRATOR:SAHAGUN, LAILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
4085617196
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:14CENSUS: 8DATE:
08/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:SAHAGUN, LAILATIME COMPLETED:
02:10 PM
NARRATIVE
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On August 21, 2019 Analysts (LPA) Stephanie Collins conducted an annual inspection of the family day care home. LPA met with Licensee, Sahagun, Laila and explained the purpose of today's inspection. Upon LPAs' arrival, volunteer Yucellin Munoz-Flores was present in the home and providing care to eight children. Thus, the home has eight children present, of whom 3 three were infant age.

Days and hours of operation are Monday through Friday from 07:30 AM – 6:00 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 which has a maximum capacity of eight.

Licensee resides in the home with her son and daughter who are under the age of 18 years. A review of records on 08/20/2019 show that 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.

Licensee Pediatric CPR and First Aid expires on August 21, 2020. Licensee has records showing proof of immunity against Measles and Pertussis.

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.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
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 5
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2019
Section Cited

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OPERATION OF A FAMILY CHILD CARE HOME. An emergency information card shall be maintained for each child [...] and the parent's authorization for the licensee or registrant to consent to emergency medical care.
This requirement is not met as evidenced by:
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Based on LPA review of the files during inspection, Childern 4,1,2 -7 are missing a completed form LIC627 "Consent for Emergency Medication Treatment.

This poses a potential risk to the safety of children in care.
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Type B
08/28/2019
Section Cited

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OPERATION OF A FAMILY CHILD CARE HOME. A file of affidavits signed by each parent with a child enrolled in the home shall be kept by the licensee [...] if the family child care home does not carry liability insurance or a bond standards established by the state.

This requirement is not met as evidenced by:
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Per LPA review of files during inspection, Child 4,1,-7 do not have a signed form LIC282 "Affidavit Regarding Liability Insurance" even though Licensee currently does not carry liability insurance.

This poses a potential risk to the health and safety 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: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2019
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SAHAGUN, LAILA
FACILITY NUMBER: 434413713
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2019
Section Cited

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IMMUNIZATION. The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
This requirement is not met as evidenced by:
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Per LPA review of the children's files, Child 1,4-7 is in care but Licensee does not have documentation of Child 1's immunization during the inspection.

This poses a potential risk to the health and safety of children in care.
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Type B
08/28/2019
Section Cited

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MANDATED REPORTER TRAINING. [...] 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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Licensee and volunteer (Yuclelin Munoz Flozes) did not have a Certification of Completion of the AB1207 Mandated Reporter Training for review during the inspection.

This poses a potential risk to children's health and safety when Licensee begins operating.
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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: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2019
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SAHAGUN, LAILA
FACILITY NUMBER: 434413713
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2019
Section Cited

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HEALTH & SAFETY CODE. Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. [...] The day care center shall maintain documentation of the required immunizations.
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This requirement is not met as evidenced by:

Per LPA review of files, volunteer (Yucelin Munoz-Flores) does not have documented evidence of immunity against Measles available for review during the inspection.

This poses a potential risk to the health and safety 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: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 08/21/2019
NARRATIVE
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LPA inspected the indoor and outdoor areas of the home. Off limits areas in the home are garage, master bedroom/bath and outside deck. Off limits areas in the back yard are storage shed and Trampoline; The backyard is fully fenced Licensee states the trampoline is off limits to day care children. Licensee stated that the children do not use the backyard for outdoor play activities at this time due to yard is under reorganization. Front-yard is fully fenced and used as an outdoor play area with sufficient materials, toys, and play equipment. There were no bodies of water observed.

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 not accessible to the day care children. Per Licensee, the dog is current with vaccination.

Licensee stated she does not transport children. 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 she is currently providing Incidental Medical Services and was informed to submit her Plan for Providing IMS to the CCL Office. 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.

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: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5