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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414734
Report Date: 02/14/2023
Date Signed: 02/14/2023 04:20:57 PM


Document Has Been Signed on 02/14/2023 04:20 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:SUTACHAN, LIDAFACILITY NUMBER:
434414734
ADMINISTRATOR:SUTACHAN, LIDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 306-8241
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:14CENSUS: DATE:
02/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:13 PM
MET WITH:Lida SutachanTIME COMPLETED:
04:30 PM
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On 02/14/2023 at 12:13 PM, Licensing Program Analyst (LPA) Teodoro Trujillo arrived and knocked front for several minutes until assistant Sonia opened the at 12:20 PM, LPA explained the reason for the visit to her, licensee Lida arrived at 12:25 PM. Present during today's visit were licensee, two assistant's Sonia, Diana and licensee's spouse with 12 children: eight preschool and four infants. Adults living in the home are licensee and spouse Manuel and two minor children ages 7 and 16. Days and hours of operation are Monday through Friday 8:00 AM to 5:30 PM.
A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 02/13/2023 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. 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 inspected inside and outside of the home. LPA observed a barricaded fireplace closed off inside the home, no wall heater, no stairs and no bodies of water. Licensee stated there are no weapons. Licensee has one small dog. LPA observed a fully charged 2A10BC fire extinguisher last serviced 1/13/2023. Carbon Monoxide detector and smoke detectors were operable. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children. Off limit inside areas: Kitchen, room 1 and 2, living room, bath 2 and laundry room. Off limit outside: Left and right side back yard and back storage shed. Children were supervised during the visit and LPA went over substitute options and reminded licensee they could only have 14 children according to their license. Licensee stated they do not transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size. Continues on report dated 02/14/2023

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
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 3


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: SUTACHAN, LIDA
FACILITY NUMBER: 434414734
VISIT DATE: 02/14/2023
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Continuation of report dated 02/14/2023 pg. 2/2

LPA observed a fire and disaster drill log that was last conducted on 02/10/2023. LPA reviewed 5 children’s files and observed all required documentation was in compliance. The 15 minute check sleep log for infants under 24 months was discussed. LPA observed that the Licensee has Mandated Reporter training, training was completed on 03/03/2022, assistants Sonia completed 9/03/2021 and Diana completed 1/09/2023. Licensee has Pediatric CPR/1st Aid expiring 06/04/2024, assistants Sonia expiring 8/09/2023 and Diana expiring 1/21/2025. Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is on file for licensee and assistants.

Incidental Medical Services (IMS) policy was discussed with the licensee. PIN 22-02-CCP was provided. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is providing IMS at this time. Licensee will submit an updated plan of operation for any IMS services to a child in care.

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.

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.

No deficiencies were cited during today's visit. Exit interview conducted and report was reviewed with the licensee, Lida Sutachan. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3