434414727-7-16-2019-07-CC-MMOO-BE5UJV-20190716153811

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414727
Report Date: 07/16/2019
Date Signed: 07/16/2019 03:38:16 PM

COMPREHENSIVE INSPECTION

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:	BARBOZA MENDIOLA, SOFIA ROSA		FACILITY NUMBER:	434414727
ADMINISTRATOR:	BARBOZA MENDIOLA, SOFIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 653-9040
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY:	14	CENSUS: 12	DATE:	07/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:42 PM
MET WITH:	Sofia Barboza Mendiola		TIME COMPLETED:	03:45 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 Analysts (LPAs), Marilou Monico and Nancy Rodriguez, made an unannounced annual random inspection. LPAs met with Licensee, Sofia Barboza Mendiola, and explained the nature of today's visit. Also present in the home were licensee's 13-year-old son, adult helper, and 12 daycare children including 4 infants and 8 preschool age. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM. There are three adults living in the home: licensee and her two children. LPAs toured the home both indoor and outdoor. LPAs observed sufficient materials, toys, and play equipment for the day care children. The home is clean and orderly. There is a fully charged 3A40BC fire extinguisher, working smoke detector, functioning carbon monoxide detector, glass covered fireplace, barricaded wall heater, and no bodies of water. Off limit areas in the home: 2 bedrooms, master bedroom, master bathroom, furnace closet, and garage. There are no off limit areas outside the home. Medications, cleaning compounds, sharp objects, and other similar items are stored out of reach of children. Per licensee, there are no weapons in the home. Eight children's files were reviewed. Licensee maintains a current children's roster and fire drill log. LPAs obtained copy of children's roster. Licensee has current CPR/First Aid certifications with an expiration date of August 19, 2019. The home has a working telephone which is (415) 653-9040. LPA discussed Senate Bill 792, 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. AB 633 was discussed with Licensee. Licensing forms, Title 22 regulations, can be obtained through the internet at ww.ccld.ca.gov. Mandated Reporter Training can be accessed at www.mandatedreporterca.com. Licensee and her helper have completed the Mandated Reporter Training. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPAs provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. (REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 07/16/19):

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

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: BARBOZA MENDIOLA, SOFIA ROSA	FACILITY NUMBER: 434414727
	VISIT DATE: 07/16/2019

NARRATIVE

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(CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 07/16/19):

This facility provides Incidental Medical Services – IMS. LPAs reviewed storage of medication and equipment/supplies, and reviewed child's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) 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.

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 exemption.

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

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

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

LIC809 (FAS) - (06/04)

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