434414527-3-6-2020-07-CC-JTSE-BMFPN6-20200306102725

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414527
Report Date: 03/06/2020
Date Signed: 03/06/2020 10:27:32 AM

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:	SALAS, INOCENCIA		FACILITY NUMBER:	434414527
ADMINISTRATOR:	SALAS, INOCENCIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 685-2422
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94085
CAPACITY:	14	CENSUS: 4	DATE:	03/06/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Inocencia Salas		TIME COMPLETED:	10:35 AM

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	LPA Janet Tse met with licensee Inocencia Salas for a required annual inspection. Present were four children including one infant in the home with Licensee. Adults living in the home are Licensee, her two adult sons, and her adult daughter with children ages 16 and 5 1/2. Days and hours of operation are Monday to Friday, 7:30am to 5:30pm. LPA toured the indoor and outdoor of the home. LPA observed a barricaded wall heater. Off limits indoor: bedroom 2, bedroom 3, and the garage. There are no bodies of water. Licensee stated there is no firearms/weapons in the home. Sharp objects, medicines, poisons and cleaning supplies were inaccessible to the children. Backyard is fenced. LPA observed a barricaded storage room in the backyard. Off limits outdoor: left side yard. LPA reminded licensee that she can only have 14 children according to her license. Fire extinguisher was size 3A40BC and filled. Smoke detector and carbon monoxide detector were operable. Home was clean and orderly with heating and ventilation for safety and comfort. LPA observed sufficient materials, toys, and play equipment for the daycare children. Telephone was in working order. Children were supervised on the visit and LPA went over substitute options. LPA also discussed if Licensee transports children, they are never to be left in parked vehicles. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 03/03/2020 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions except for Licensee's son Faustino Salas. LPA observed there is a data entry error in the system. The facility number was incorrect. Caregiver Background Check Bureau (CBCB) will be contacted to correct the error. LPA reviewed four files. LPA observed that in each child’s record has a copy of the emergency information Facility Evaluation Report dated 03/06/2020 to be continued on next page: - Page 1 of 2 -

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

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 2

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: SALAS, INOCENCIA	FACILITY NUMBER: 434414527
	VISIT DATE: 03/06/2020

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
26
27
28
29
30
31
32

Facility Evaluation Report dated 03/06/2020 to be continued from previous page:
card that contains all of the information specified by regulation. LPA observed that Licensee has current Pediatric CPR/1^st Aid expiring 10/27/2020. A copy of the current roster of the children was provided to LPA today.

Licensee was given a list of the current forms for childcare. Website to download forms and to review regulations: http://www.ccld.ca.gov.

LPA discussed the immediate civil penalties for Zero Tolerance of $500, and an ongoing $100 per day per violation continues until the violation(s) is corrected. LPA also discussed the Healthy Beverage Act and AB633 requirements for type A violation. AB792 Immunization Requirements was discussed. LPA observed the required immunization records for Licensee and her assistant (MS) were in file.

Effect of Lead Exposure handout dated 1/20/19 given during today’s inspection. Licensee understands that per Assembly Bill (AB 2370), written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians. LPA reviewed infants safe sleep policies with Licensee and provided "A Child Care Provider's Guide to Safe Sleep.” More information can be found at https://cdss.ca.gov/inforesources/Child-Care-Licensing. Incidental Medical Services were discussed with the licensee. The licensee is not providing IMS (Incidental Medical Services) at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

The Mandated Reporter AB1207 Compliant Child Care Training was also discussed. Website to complete training: https://mandatedreporterca.com. A link to the alternate trainers approved to provide training:
https://www.cdss.ca.gov/Portals/9/CCLD/CCP%20Documents/Approved%20Mandated%20Reporter%20Trainings.pdf Licensee's primary language is Spanish and is currently exempt from the training. However, Licensee and her assistant (MS) have completed the training on 07/29/2019 and 08/18/2019 respectively. Licensee understands that the training is to repeated once every two years.

Website for provider resources: https://cdss.ca.gov/inforesources/Child-Care-Licensing Periodic information releases accessible by signing up at: www.myccl.ca.gov.

No deficiency was cited. Notice of site visit was issued and must be posted for 30 days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2