434414698-2-8-2023-07-CC-MMOO-CNUR47-20230208114105

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414698
Report Date: 02/08/2023
Date Signed: 02/08/2023 11:41:13 AM

Document Has Been Signed on 02/08/2023 11:41 AM - 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:	NEINAVAIE, SHEILA		FACILITY NUMBER:	434414698
ADMINISTRATOR:	NEINAVAIE, SHEILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 709-0396
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95130
CAPACITY:	14	CENSUS: 9	DATE:	02/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:07 AM
MET WITH:	Sheila Neinavaie		TIME COMPLETED:	11:55 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	Licensing Program Analysts (LPAs), Marilou Monico and Jovani Dillon, conducted an unannounced Required - 1 Year Inspection. LPAs met with Licensee, Sheila Neinavaie, and explained to her the nature of today's visit. Also present in the home were licensee's adult assistant and nine (9) daycare children including four (4) infants and five (5) preschool age. All required posted materials were posted by the entrance. The daycare is open Monday thru Friday from 7:30 AM to 6:00 PM. There are no active waivers or exceptions for this facility. Per Licensee, the adults residing in the home are herself and her husband. LPAs toured the indoor and outdoor areas of the home. LPAs observed a fully charged 3A40BC fire extinguisher, functioning smoke and carbon monoxide detectors, and barricaded fireplace. Licensee states that there are no weapons or firearms in the home. LPAs observed a current children's roster and copy was obtained during the inspection. Fire/disaster drill was conducted on February 6, 2023. Incidental Medical Services (IMS) policy was discussed. Licensee states that she is not planning to administer any medication at this time. 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 LPAs reminded licensee 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. Continuation on next page:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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 4

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: NEINAVAIE, SHEILA	FACILITY NUMBER: 434414698
	VISIT DATE: 02/08/2023

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

LPAs observed that licensee is using Bedroom #2 which was previously identified as off limit area for daycare. Licensee requested to include the room on-limits to children. Off limit areas in the home now include: master bedroom, master bathroom, and the garage. LPAs observed that the home is clean and orderly. Cleaning products, sharp objects, and other items that are dangerous to children were stored inaccessible. LPAs observed sufficient age-appropriate materials, toys, and play equipment in the facility. The children's bathroom is clean, sanitary, and operable. The home has a working telephone which is (408) 709-0396. Off limit areas outside the home: both side yards. No bodies of water were observed.

LPAs reviewed 10 children’s files for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Immunization Records, and Notification of Additional Children in Care (LIC 9150). Licensee carries daycare insurance.

LPAs reviewed a helper's file for the following records: Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), Employee Rights (LIC 9052), required immunizations, TB test, and Mandated Reporter Training. Licensee's Mandated Reporter Training expires on October 30, 2024. LPAs reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years. Licensee has current Pediatric CPR/First Aid certification with an expiration date of February 4, 2025.

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 Sheila Neinavaie, Licensee.

As a result of today's inspection, deficiency was cited on the following page:

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

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4

Document Has Been Signed on 02/08/2023 11:41 AM - It Cannot Be Edited

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: NEINAVAIE, SHEILA	FACILITY NUMBER: 434414698
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.3(a)(6)

Alterations to Existing Building or Grounds

(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observation, licensee is using Bedroom #2 which was previously identified as "off limits" for daycare without notifying Licensing. This poses a potential risk to the health, safety or personal rights risk of children in care.
	POC Due Date: 02/08/2023
	Plan of Correction
1 2 3 4	Licensee states she will submit a written plan to ensure that in the future, prior to using an off limit areas for daycare, she will notify Licensing. Licensee submitted a written plan of correction during the inspection. Deficiency corrected.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4