434415187-1-6-2025-07-CC-LFII-DCNVMA-20250106153313

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415187
Report Date: 01/06/2025
Date Signed: 01/06/2025 03:33:26 PM

Document Has Been Signed on 01/06/2025 03:33 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	MACHUCA, ROMELIA & FLORES, ROSINA		FACILITY NUMBER:	434415187
ADMINISTRATOR/ DIRECTOR:	MACHUCA, ROMELIA & FLORES,		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 842-6907
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	01/06/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:40 PM
MET WITH:	Machuca, Romelia		TIME VISIT/ INSPECTION 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	On 1/6/2025, at 1:40 PM, Licensing Program Analyst (LPA) Liridon Fici (Doni) arrived unannounced to conduct an Annual/Random inspection and was greeted by Licensee, Machuca, Romelia. LPA also informed Licensee the purpose of today’s visit. During visit, there were two (2) staff and zero (0) children present. Licensee stated that her, her mom, her friend, and her two (2) daughters are the adults residing at the home. Licensee stated she has another child which is a minor (17 years old) living in the home as well. All are fingerprint cleared and associated to the facility. A review of children roster indicated 0 infants are being cared for. The day care is located in the back room located passed the kitchen of the house. Parents will enter from the front of the house. The front part of the home is off limits from the day care. The home has no stairs going up to the second floor. Days and hours of operation are Monday - Friday from 7:00 AM to 5:00 PM. LPA reviewed Fire/Disaster drill log during today's inspection was conducted on 12/9/2024. LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee’s has a working cell phone 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. The backyard is enclosed by a fence. Continue on page 2...

Gladys Kuizon	TELEPHONE: (510) 566-5850
Liridon Fici	TELEPHONE: 408-598-9250
	DATE: 01/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MACHUCA, ROMELIA & FLORES, ROSINA	FACILITY NUMBER: 434415187
	VISIT DATE: 01/06/2025

NARRATIVE

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Off limit areas inside Licensee's home: All bedrooms downstairs, laundry room, staff bathroom and the front of the house. There are no off limits to the outside area. LPA toured the backyard area and observed the backyard area is adequately fenced and there are no bodies of water. There is a designated area in the living room with space where child(ren) can be isolated if exhibiting any signs of illness until the child's parent(s) pick them up.

Licensee provides breakfast, lunch, and dinner along with snacks for the children in between. Licensee will not accept outside food from parents and Licensee will prepare and cook meals for children. LPA observed a first aid kit in the day care. Staff stated that nobody smokes, and she understands that smoking is prohibited in the day care. LPA observed a fully charged 3A4BC fire extinguisher last time serviced on 7/20/2024, with working smoke and carbon monoxide detectors. The Licensee stated that there are no weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.

LPA reviewed a random selection of five (5) children's file and observed that parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification forms are in each file. LPA observed 15-minute sleep logs for an infant in care.

Licensee and Staff files were reviewed for the following records: Employee Rights (LIC9052), Statement Acknowledging Requirement to report Child Abuse (LIC9108), and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza (or statement declining influenza). Licensee has a current Mandated Reporter Training and was conducted on 9/10/2024. Licensee has current Pediatric CPR/FIRST AID that was conducted on 5/1/2023. LPA informed Licensee that Mandated reporting and First aid/CPR is mandatory and should be renewed every 2 years.

Incidental Medical services (IMS) policy was discussed. Licensee does not handle any medications. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417 and PIN 22-02-CCP...

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SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Liridon Fici	TELEPHONE: 408-598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MACHUCA, ROMELIA & FLORES, ROSINA	FACILITY NUMBER: 434415187
	VISIT DATE: 01/06/2025

NARRATIVE

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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 (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. Licensee does not have any children taking medication.

Supervision of children was discussed with licensee, and she understands that she must be present in the home during day care hours and ensure that the children are always supervised. Licensee understands her capacity options and she understand that she cannot have more than 14 children in the home at any time. Licensee understands if she transports children via vehicle, children cannot be left in parked vehicles unattended at any time.

LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

LPA discussed the requirements of AB 633 with the Licensee and understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

The licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

The following type B deficiency was cited on the attached page (809-D). Licensee was informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted with Licensee, and a copy of this review was reviewed and provided along with appeal rights.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Liridon Fici	TELEPHONE: 408-598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/06/2025 03:33 PM - It Cannot Be Edited

Created By: Liridon Fici On 01/06/2025 at 03:18 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MACHUCA, ROMELIA & FLORES, ROSINA	FACILITY NUMBER: 434415187
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

1597.622 (c) Employees or volunteers at family day care home; immunization requirements; records; exemptions: (c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above by not maintaining Immunization records in file for Staff 2 (S2) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/13/2025
	Plan of Correction
1 2 3 4	Licensee agreed to submit proof of immunization for S2 to CCL by POC due date.

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:

Gladys Kuizon

TELEPHONE: (510) 566-5850

LICENSING EVALUATOR NAME:

Liridon Fici

TELEPHONE: 408-598-9250

LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025

LIC809 (FAS) - (06/04)

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