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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415257
Report Date: 12/19/2019
Date Signed: 12/19/2019 01:38:15 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:RECINOS, BLANCA & JOSEFACILITY NUMBER:
434415257
ADMINISTRATOR:BLANCA & JOSEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 261-1033
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:14CENSUS: 9DATE:
12/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Amalia AlejandroTIME COMPLETED:
01:00 PM
NARRATIVE
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LPA Janet Tse met with licensees' assistant Amalia Alejandro for an annual/random inspection. LPA explained the nature of today's visit to the Assistant. At arrival, LPA observed five children including two infants with Assistant in the home. Around 10:00am, two children including one infant arrived. An infant left for a doctor's appointment at 10:30am and returned to the home at 12:03pm. Two additional children (one school age and one preschooler) arrived at 11:50am. LPA observed a total of nine children including three infants and one school age with the Assistant alone in the home during the inspection. The family child care home was operating out of ratio/capacity. LPA observed the Assistant does not have current CPR/1st Aid certification. Present was also licensees' son Yoy Recinos in his bedroom. Adults living in the home are licensees and their adult son. The Assistant and her daughter have moved out of the home since August 2018. Licensing was not advised of the change in household composition. Days and hours of operation are Monday to Sunday, 6:00am to 6:00pm.

LPA toured the indoor and outdoor of the home. LPA observed a blocked fireplace and no wall heaters. LPA observed no stairs. Off limits indoor: master bedroom, master bathroom, two bedrooms, one bathroom, kitchen, and the laundry room. There are no bodies of water. The Assistant stated there is no firearms/weapons in the home. LPA observed shampoos on the shower floor and cleaning agents underneath the sink accessible to children in the children's bathroom. The backyard is fenced. LPA observed two dogs in the backyard. Assistant does not know if the dogs are vaccinated; and proof of vaccination was not available for LPA to review during the inspection. LPA observed the off limits side yard with chemicals and items dangerous to children was not barricaded and the fence was broken. LPA observed a bottle of heavy duty stripper accessible to children in another off limits area with the gate open. A bottle of chemical was accessible to children on top of a file cabinet next to a couch in the backyard accessible to children. Off limits outdoor: detached garage, both side yards and fenced off area. LPA reminded the Assistant that licensees can only have 14 children according to their license, and if there is only one person caring for the children, the ratio and capacity of a small family child care license applies.

Fire extinguisher is size 2A10BC and filled. Smoke and carbon monoxide detectors are operable. LPA

Facility Evaluation Report dated 12/19/2019 to be continued on next page: - Page 1 of 3 -
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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 9
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: RECINOS, BLANCA & JOSE
FACILITY NUMBER: 434415257
VISIT DATE: 12/19/2019
NARRATIVE
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Facility Evaluation Report dated 12/19/2019 to be continued from previous page:

observed sufficient materials, toys, and play equipment for the day care children. Telephone is in working order. Children were supervised on the visit and LPA went over substitute options. LPA also discussed if
licensees transport children, they are never to be left in parked vehicles and car seat laws are to be followed.

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 12/16/2019 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.

LPA observed the roster of the children is not current. LPA observed three of the children (child #1, 2, 3) present did not have a child's file. Licensees do not carry liability insurance and LPA observed no LIC 282 Affidavits Regarding Liability Insurance in the children's files. Assistant stated that there are 13 children enrolled in the family child care home.

The Assistant was given a list of the current forms for childcare. Website to download forms, obtain information and to review regulations: http://www.ccld.ca.gov.

LPA discussed the immediate civil penalties for Zero Tolerance of $500, and an ongoing $100 per day per violation continues until the violation(s) is corrected. LPA also discussed the Healthy Beverage Act and AB633 requirements for type A violation. AB792 Immunization Requirements was discussed. LPA observed the required immunization records for Licensee and the Assistant were in file.

Effect of Lead Exposure handout dated 1/20/19 given during today’s inspection. Per Assembly Bill (AB 2370), written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians. The Assistant was provided "A Child Care Provider's Guide to Safe Sleep" for Licensees. More information can be found at https://cdss.ca.gov/inforesources/Child-Care-Licensing. Licensees are not providing IMS (Incidental Medical Services) at this time. Licensees will submit an updated plan of operation if in the future they provide any IMS services to a child in care. The Mandated Reporter AB1207 Compliant Child Care Training was also discussed. Website to complete training: https://mandatedreporterca.com. Licensees' and the Assistant's primary language is Spanish and is currently exempt from the training.

Facility Evaluation Report dated 12/19/2019 to be continued on next page: - Page 2 of 3 -
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 9
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: RECINOS, BLANCA & JOSE
FACILITY NUMBER: 434415257
VISIT DATE: 12/19/2019
NARRATIVE
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Facility Evaluation Report dated 12/19/2019 to be continued from previous page:

Periodic information releases accessible by signing up at: www.myccl.ca.gov.

LPA discussed the requirements of AB633 to the Assistant and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and the Assistant understands the requirements. Upon receipt, licensees shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Deficiencies were cited. Notice of site visit was issued and must be posted with type A deficiency cited for 30 days.

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

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 9
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: RECINOS, BLANCA & JOSE
FACILITY NUMBER: 434415257
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/20/2019
Section Cited

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Staffing Ratio and Capacity. If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
This requirement was not met as evidenced by:
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LPA observed seven children including three infants with licensee's assistant alone in the home during the inspection.

This poses an immediate risk to the Health, Safety, or Personal Rights of children in care.
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AB633 Parent Notification is required.
This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.

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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 4 of 9
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: RECINOS, BLANCA & JOSE
FACILITY NUMBER: 434415257
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited

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Operation of a Family Child Care Home. Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement was not met as evidenced by:
LPA observed the roster of the children is not current.
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This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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Type B
01/10/2020
Section Cited

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Child's Records. The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7).
This requirement was not met as evidenced by:
LPA observed three of the children
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(child #1, 2, 3) present did not have a child's file.

This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 5 of 9
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: RECINOS, BLANCA & JOSE
FACILITY NUMBER: 434415257
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited

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Operation of a Family Child Care Home. An emergency information card shall be maintained for each child and shall include ... the parent's authorization for the licensee or registrant to consent to emergency medical care.
This requirement was not met as evidenced by:
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LPA observed three of the children (child #1, 2, 3) present did not have a child's file.

This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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Type B
01/10/2020
Section Cited

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Immunizations. The licensee shall document each child's immunizations as required by the California Code of Regulations... This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.
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This requirement was not met as evidenced by:
LPA observed three of the children (child #1, 2, 3) present did not have a child's file.
This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 6 of 9
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: RECINOS, BLANCA & JOSE
FACILITY NUMBER: 434415257
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited

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Admission Procedures and Parental and Authorized Representative's Rights. At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parents’ Rights, LIC 995A...
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This requirement was not met as evidenced by:
LPA observed three of the children (child #1, 2, 3) present did not have a child's file.
This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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Type B
01/10/2020
Section Cited

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Operation of a Family Child Care Home. A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.
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This requirement was not met as evidenced by:
Licensees do not carry liability insurance and LPA observed no LIC 282 Affidavits Regarding Liability Insurance in the children's files.

This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 7 of 9
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: RECINOS, BLANCA & JOSE
FACILITY NUMBER: 434415257
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited

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Staffing Ratio and Capacity. For a Family Child Care Home that meets the criteria in Sections 1597.44 or 1597.465 of the Health and Safety Code to care for up to two additional children, the licensee shall maintain proof of parent notification in the child’s record pursuant to Section 102421.
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This requirement was not met as evidenced by:
Assistant stated that there are 13 children enrolled in the family child care home. LPA observed three children (child #1, 2, 3) present did not have a child's file.
This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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Type B
01/10/2020
Section Cited

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Personnel Requirements. The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement was not met as evidenced by:
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LPA observed the Assistant does not have current CPR/1st Aid certification while caring for the day care children alone by herself.

This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 8 of 9
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: RECINOS, BLANCA & JOSE
FACILITY NUMBER: 434415257
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited

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Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:...Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to
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children shall be stored where they are inaccessible to children.
This requirement was not met as evidenced by:
LPA observed items dangerous to the health and safety of the children accessible to children both inside and outside of the home.
This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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Type B
12/10/2019
Section Cited

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Reporting Requirements. The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm).... Any change in household composition including adults moving in or out of the home...
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This requirement was not met as evidenced by:
The Assistant and her daughter have moved out of the home since August 2018. Licensing was not advised of the change in household composition.
This poses a potential risk to the Health, Safety, or Personal Rights of children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 9 of 9