434414790-10-25-2019-07-CC-MSMS-BHAR5Q-20191025124332

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414790
Report Date: 10/25/2019
Date Signed: 10/25/2019 12:43:39 PM

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:	OLIVERA, LAURA MICHELE		FACILITY NUMBER:	434414790
ADMINISTRATOR:	LAURA MICHELE OLIVERA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 794-9330
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94089
CAPACITY:	14	CENSUS: 13	DATE:	10/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Laura Michele Olivera		TIME COMPLETED:	12:55 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) Mel Matos met with Laura Michele Olivera, Licensee, for an unannounced annual/random inspection. LPA notes that the Licensee resides in the Arches Apartment Homes in Building 18, Unit 137 (lower unit). LPA observed three adult assistants (Felicia Diaz, Paula Olivera, and Reyna Olivera) and 13 day care children (2 infants, 10 preschool, and 1 school age) in the home during today's inspection. Days and hours of operation are Monday - Friday from 7:30 AM to 5:30 PM. The Licensee is the only adult residing in the home. Licensee's certifications for CPR and First Aid are current and expire in May 2021. Two of the Licensee's adult assistants (Paula & Reyna Olivera) also have valid CPR and First Aid certifications which expire in May 2021. LPA reviewed the Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on August 10, 2019. LPA reviewed thirteen children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. LPA observed that the Licensee has record of MMR & Tdap vaccinations as well as the opt out form for the flu vaccine. The Licensee completed the Mandated Reporter Training for Child Care Workers on June 28, 2018. Paula and Reyna Olivera completed their Mandated Reporter Training for Child Care Workers on August 19, 2018. Felicia Diaz completed the Mandated Reporter Training for Child Care Workers on September 2, 2018. LPA reminded the Licensee that the Mandated Reporter Training for Child Care Workers must be renewed every two years. LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. Off limit areas in the home: one closet in the bedroom. There are no stairs inside the home. Off limit areas outside the home: outdoor patio area. There are stairs outdoors within the apartment complex and LPA advised the Licensee that the day care children must be supervised at all times whenever they are outdoors. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 10/25/2019):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

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: OLIVERA, LAURA MICHELE	FACILITY NUMBER: 434414790
	VISIT DATE: 10/25/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 10/25/2019):

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detector, and fenced patio area. There is a swimming pool in the middle of the complex that is appropriately fenced with a self-latching gate. The Licensee states that the day care children don't use the swimming pool. The Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.

A review of staff records on October 16, 2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded the Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time with a qualified assistant present. The Licensee also understands that she must comply with the capacity and ratio requirements of the small Family Child Care Home License whenever there is only one qualified adult present with the day care children. The Licensee states that she transports children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.

Website for provider resources & to obtain updates re: pending safe sleep regulations: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

LPA conducted an exit interview with the Licensee prior to the conclusion of today's inspection and the Licensee agreed to submit a copy of certificate of completion for the Mandated Reporter Training for Child Care Workers and immunization records (MMR, Tdap, and flu vaccine) by Friday November 1, 2019.

No deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

LIC809 (FAS) - (06/04)

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