434414222-4-21-2022-07-CC-MMOO-CDPRR9-20220421131446

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414222
Report Date: 04/21/2022
Date Signed: 04/21/2022 01:14:59 PM

Document Has Been Signed on 04/21/2022 01:14 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, CATHERINE		FACILITY NUMBER:	434414222
ADMINISTRATOR:	BRIONES, CATHERINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 338-8644
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	04/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:38 AM
MET WITH:	Catherine Briones		TIME COMPLETED:	01:30 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), Marilou Monico, met with Licensee, Catherine Briones, for an unannounced Required - 1 Year Inspection. Also present in the home were licensee's husband, licensee's aunt (helper) and seven (7) daycare children including three (3) infants and four (4) preschool age. LPA was granted access to the home by the Licensee and toured both indoor and outdoor areas during the inspection. LPA observed all required posted materials. Days and hours of operation for the facility are Monday – Friday, 7:00 AM- 6:00 PM. There are no active waivers or exceptions for this facility. Licensee states there are three adults residing in the home: herself, her husband, and her aunt. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. LPA reviewed and obtained copy of facility roster (LIC9040). Fire/disaster drill was conducted on March 11, 2022. LPA observed a fully charged 3A40BC fire extinguisher, barricaded fireplace, and functioning smoke and carbon monoxide detectors. Licensee states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. Licensee states that there are no weapons or firearms in the home. Incidental Medical Services (IMS) policy was discussed. 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 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 Continuation on next pages:

Joel Segura
Marilou Monico
	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

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: BRIONES, CATHERINE	FACILITY NUMBER: 434414222
	VISIT DATE: 04/21/2022

NARRATIVE

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Indoor licensed areas of the facility were inspected by LPA today and observed to be clean, orderly, and safe for the day care children. Off limit areas in the home: master bedroom, master bathroom, 2 bedrooms, furnace closet, and garage. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. Furniture, such as tables, chairs, couches, and shelves are in good condition and safe for children. The floors were clean and free of tripping hazards. Drinking water is readily available for children in the facility via individual water bottles. The children's bathroom is clean, sanitary, and operable. The home has a working telephone which is (408) 338-8644.

The outdoor licensed areas of the home were inspected and observed to be fenced in. Off limit areas outside the home: two storage sheds and front yard. There were no bodies of water observed.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Seven (7) children’s files were reviewed during todays inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical (LIC627), Identification and Emergency Information (LIC700), Affidavit Regarding Liability Insurance (LIC282), and Immunization Records.

LPA reviewed a helper's file. Licensee has Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and flu. The Licensee has Mandated Reporter Training that expires on July 30, 2023. Licensee's CPR/First-Aid expires on March 10, 2023. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years.

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SUPERVISOR'S NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

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: BRIONES, CATHERINE	FACILITY NUMBER: 434414222
	VISIT DATE: 04/21/2022

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Exit interview conducted and report was reviewed with the Licensee, Catherine Briones.

As a result of todays inspection, there were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

LIC809 (FAS) - (06/04)

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