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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414222
Report Date: 07/28/2021
Date Signed: 07/28/2021 03:15:55 PM

Document Has Been Signed on 07/28/2021 03:15 PM - It Cannot Be Edited

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:BRIONES, CATHERINEFACILITY NUMBER:
434414222
ADMINISTRATOR:BRIONES, CATHERINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 338-8644
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
07/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:42 PM
MET WITH:Catherine BrionesTIME COMPLETED:
03:30 PM
NARRATIVE
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#2 Licensing Program Analysts (LPAs), Marilou Monico and Cortney Nelson, conducted a Required - 1 Year inspection. LPAs met with Licensee, Catherine Briones, and explained the purpose of today's visit. Also present in the home were licensee's helper, licensee' s adult son, and nine (9) daycare children including four (4) infants and five (5) preschool age. There are four (4) adults residing in the home: licensee, her husband, her son, and her helper. The home has four bedrooms and two bathrooms. The daycare is open Monday to Friday from 7:00 AM to 6:00 PM.

LPAs toured the home inside and out with the Licensee. LPAs observed sufficient toys and play equipment for the day care children. Bathroom used by children was observed to be clean and in good condition.

Off limit areas in the home: master bedroom, master bathroom, 2 bedrooms, furnace closet, and garage. Off limit areas outside the home: two storage sheds and front yard. There were no bodies of water observed. Per Licensee, there are no weapons in the home. LPAs observed a fully charged 3A40BC fire extinguisher, functioning carbon monoxide detector, working smoke detector, glass covered fireplace, and fenced backyard. Cleaning compounds, detergents, medications, sharp objects, and other similar items were stored inaccessible to children.

LPA discussed with Licensee Assembly Bill (AB) 1207 (Mandated Child Abuse Reporter Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at www.mandatedreporterca.com. Mandated Reporter Training (AB1207) for licensee and her helper are expired. Licensee, her husband, and her helper have current Pediatric CPR/1st Aid certifications with an expiration date of March 10, 2023.

Continuation on next page:
Anthony Studebaker
Marilou Monico
DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: BRIONES, CATHERINE
FACILITY NUMBER: 434414222
VISIT DATE: 07/28/2021
NARRATIVE
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A review of staff records during today's inspection 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 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.

LPA reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoptions of new laws, pay annual fees etc.
LPA reviewed with Licensee and provided her a copy of Safe Sleep Regulations (PIN 20-24-CCP).

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she's not planning to provide IMS at this time.

As a result of this inspection, deficiency was cited on the following page:



A NOTICE OF SITE VISIT WAS POSTED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/28/2021 03:15 PM - It Cannot Be Edited


Created By: Marilou Monico On 07/28/2021 at 02:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: BRIONES, CATHERINE
FACILITY NUMBER: 434414222

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2021
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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This requirement is not met as evidenced by: Per review of record, licensee and her helper have expired Mandated Reporter Training. 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:Anthony Studebaker
TELEPHONE:
LICENSING EVALUATOR NAME:Marilou Monico
TELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2021


LIC809 (FAS) - (06/04)
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