434415224-7-12-2019-07-CC-MSMS-BDZTN4-20190712145206

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415224
Report Date: 07/12/2019
Date Signed: 07/12/2019 02:52:11 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:	CRISTANCHO, MARIA & VALDES, MARIA		FACILITY NUMBER:	434415224
ADMINISTRATOR:	M CRISTANCHO & M VALDES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 658-3059
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY:	14	CENSUS: 10	DATE:	07/12/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Maria Angelica Cristancho & Maria Valdes		TIME COMPLETED:	03:00 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 Maria Angelica Cristancho & Maria Valdes, Licensees, for an unannounced annual/random inspection. LPA also observed Manuel Cristancho (Maria Valdes' spouse & Maria Angelica's father) and ten day care children (3 infants & 7 preschool) in the home during today's inspection. Days and hours of operation are Monday - Friday from 7:30 AM to 5:30 PM. The adults that reside in the home are both Licensees, Manuel Cristancho (spouse of Maria Valdes and Angelica's father), and Ana (daughter of Maria Valdes and Angelica's sister). Both Licensee's and Manuel Cristancho's CPR & First Aid certifications are current and expire on July 14, 2020. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Last fire/disaster drill was completed on May 8, 2019. LPA reviewed ten 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. Both Licensees completed the required Mandated Reporter Training for Child Care Workers on September 12, 2018 and copies of completion certificates were provided to LPA during today's inspection. LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensees have 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. LPA did not observe any wall heaters inside the home. Off limit areas inside the home: master bedroom, master bathroom, hallway closet, 3 locked bathroom cabinets, two locked kitchen cabinets, barricaded fireplace (located in the front living room), and attached garage. Off limit areas outdoors: right & left side sections and part of right back section of the backyard and front yard. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 07/12/2019):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

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: CRISTANCHO, MARIA & VALDES, MARIA	FACILITY NUMBER: 434415224
	VISIT DATE: 07/12/2019

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 07/12/2019):

LPA observed a fully charged 2A10BC fire extinguisher, working smoke & carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee state that they do not have any weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. All poisons are locked and inaccessible to children.

A review of staff records on July 12, 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 Licensees 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 Licensees and they understand that they must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensees understand their capacity options and they understand that they cannot have more than 12 children (landlord consent not on file) in the home at any time with a qualified assistant present. The Licensees do not transport any children. The Licensees state that they don't administer any medications.

No deficiencies issued during today's inspection.

LPA conducted an exit interview with the Licensees prior to the conclusion of today's inspection advised them of the pending Department regulation update re: safe sleep for infant children. LPA referred the Licensees to the Department website: www.ccld.ca.gov for additional information.

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: 07/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

LIC809 (FAS) - (06/04)

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