434413941-9-2-2021-07-CC-MSMS-C6GUHJ-20210902153601

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413941
Report Date: 09/02/2021
Date Signed: 09/02/2021 03:36:08 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:	MANGALINDAN, ELIZABETH & RODRIGUEZ, THERESA		FACILITY NUMBER:	434413941
ADMINISTRATOR:	MANGALINDAN & RODRIGUEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 821-0751
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94089
CAPACITY:	14	CENSUS: 11	DATE:	09/02/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Elizabeth Mangalindan & Theresa Rodriguez		TIME COMPLETED:	04:00 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) Mel Matos met with Elizabeth Mangalindan & Theresa Rodriguez, Licensee, for unannounced Required – 1 year annual inspection (KIT 1). LPA was granted access to the home by the Licensees. LPA also observed eleven day care children (2 infants, 8 preschool, & Elizabeth's 3 year child) in the home during today's inspection. The Licensees were operating within their capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 8:00 AM to 5:00 PM. The Licensees were the adults present in the home during today's inspection. Other adults living in the home but not present during today's inspection are Benjie Mangalindan (Elizabeth's spouse), Jospeh Rodriguez (Theresa's spouse), Andrew Bui (Licensees' brother), and Anh Nguyen (Licensee's sister-in-law). LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last Fire/Disaster drill was completed on June 21, 2021. The Licensees have the required vaccinations (MMR, Tdap, & flu) and are current with their Mandated Reporter Training for Child Care Workers (exp: 01/22). The Licensees CPR and First Aid are current and expire in February 2022. LPA reviewed thirteen children's files and observed current and updated Identification and Emergency Information (LIC 700) and Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. Safe sleep update: LPA discussed the new “Safe Sleep” regulations with the Licensees and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensees. LPA reminded the Licensees that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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: MANGALINDAN, ELIZABETH & RODRIGUEZ, THERESA	FACILITY NUMBER: 434413941
	VISIT DATE: 09/02/2021

NARRATIVE

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LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensees have 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. There are no stairs or wall heater units inside the home. Off limit areas inside the home: three bedrooms, barricaded fireplace, and attached garage. Off limit areas outside the home: left side yard and back section of the backyard.

LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. The Licensees state that they do not have any pets and weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Any poisons are locked and inaccessible to the day care children. The Licensees state that they do not administer any medication to the day care children. The Licensees state that a child will be isolated in the living room area of the home if needed due to illness or communicable disease.

A review of staff records on August 31, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded the 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.

Supervision of children was discussed with the Licensees and they understand that they must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensees understand their capacity options and they understand that they cannot have more than 14 children in the home at any time without two fully qualified adults present. The Licensees states that do not transport any day care children. The Licensees understand that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

LPA conducted an exit interview with the Licensees and advised them that no deficiencies issued during today's inspection.
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: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

LIC809 (FAS) - (06/04)

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