<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415224
Report Date: 08/18/2021
Date Signed: 08/18/2021 04:04:23 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, MARIAFACILITY NUMBER:
434415224
ADMINISTRATOR:M CRISTANCHO & M VALDESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 658-3059
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:14CENSUS: 8DATE:
08/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Maria Angelica Cristancho & Maria ValdesTIME COMPLETED:
04:15 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) Mel Matos and Cortney Nelson met with Maria Angelica Cristancho & Maria Valdes, Licensees, for unannounced Required – 1 year annual inspection (KIT 1). LPAs were granted access to the home by Maria Angelica. LPAs also observed eight preschool day care children, Manuel Cristancho (Maria Valdes' spouse & Maria Angelica's father), and Ana Cristancho (Maria's Valdes' adult daughter & Maria Angelica's adult sister) in the home during today's inspection. The Licensees were operating within their capacity and ratio requirements. LPAs observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 8:00 AM to 5:30 PM. The adults that reside in the home are both Licensees, Manuel Cristancho (spouse of Maria Valdes and Maria Angelica's father), and Ana (daughter of Maria Valdes and Maria Angelica's sister). Both Licensees, Ana, and Manuel have current CPR & First Aid certifications which expire November 20, 2022.

LPAs reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on March 29, 2021. The Licensees have the required immunizations (MMR, Tdap, & flu) and Mandated Reporter Training for Child Care Workers. LPAs reviewed eight children's files and observed current and updated Identification and Emergency Information (LIC 700) and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. The Licensees state that a child will be isolated in the kitchen/dining area if needed to because of illness or communicable disease.

Safe sleep update: LPAs discussed the new “Safe Sleep” regulations with the Licensee and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensee. LPAs reminded the Licensees that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.
REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 08/18/2021):
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
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 2
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: 08/18/2021
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
26
27
28
29
30
31
32
CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 08/18/2021):
LPAs toured the indoor and outdoor areas of the home during today's inspection. The Licensees have a working telephone in the home. LPAs observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPAs did not observe any stairs or wall heater units inside the home. Off limit areas inside the home: master bedroom, master bathroom, hallway closet, 3 locked bathroom cabinets, two locked kitchen cabinets (underneath kitchen sink), 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.

LPAs observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. The Licensees state that they do not have any pets and weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Any poisons are locked and inaccessible to the day care children. The Licensees state that they do not administer any medication to the day care children at this time.

A review of staff records on August 17, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPAs 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 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 at least two qualified adults present. The Licensees state that they do not transport any day care children. The Licensees understand that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Maria Angelica agreed to submit copies of current CPR/First Aid certifications, Mandated Reporter certifications, and flu vaccinations/opt out forms to LPA Matos by Friday August 27, 2021.

LPAs conducted an exit interview with the Licensees and advised that no deficiencies issue 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 StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2