434415257-12-19-2019-07-CC-JTSE-AWPSD2-20180309124626

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415257
Report Date: 03/09/2018
Date Signed: 12/19/2019 01:15:20 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 & JOSE		FACILITY NUMBER:	434415257
ADMINISTRATOR:	BLANCA & JOSE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 261-1033
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95117
CAPACITY:	14	CENSUS: 1	DATE:	03/09/2018
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Blanca & Jose Recinos		TIME COMPLETED:	12:50 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	Page 1 LPA Janet Tse met with applicants, Blanca and Jose Recinos to conduct a pre-licensing inspection for location change at this facility. LPA observed a child in the home with applicants and their assistant Amalia Alejandro. Applicants' current license is #434413982 which is located at 349 Rosewood Avenue, San Jose, CA 95117. Applicants stated that they, their adult son, their assistant, and the assistant's adult daughter reside in this home. Applicants rent this house. Applicants does not have liability insurance and they understand that they will have parent/authorized representative sign the Affidavit Regarding Liability Insurance for FCCH form (LIC 282). Fire clearance was granted on 01/22/2018. The entire home was inspected for health and safety hazards. The home had a working smoke detector, a functioning carbon monoxide detector, a working telephone and a fully charge 2A10BC fire extinguisher. Certifications for CPR and First Aid are up-to-date expiring 01/22/2019. Applicants do not have Preventative Health Practices including one hour of nutrition. Applicants scheduled the training for 03/24/2018. LPA observed four dogs in the home, and the dogs are kept in the off limits detached garage and fenced off backyard area. Applicants could not provide proof of the dogs' vaccinations. Applicants state there is no firearms or weapons in the home. Off limits indoor: two bedrooms, one bathroom, and kitchen. LPA observed no bodies of water. The backyard is fenced. Off limits outdoor: the detached garage, both side yards adjacent to the home, fenced off area next to the detached garage. The days and hours of operation will be Monday to Sunday, 24 hours. Applicants understand that no children can stay at the day care for more than 24 hours at a time. There were age appropriated toys in the day care areas. Bathroom was clean. No cleaning products, hazardous and sharp objects were accessible to children. Discipline policy was discussed with applicants and they understand that the children's personal rights should not be violated and corporal punishment is not allowed. Applicants will transport children and understand the safety seat belt/car seat requirements. Applicants also understand that children cannot be left alone in the vehicle at any time. A Family Child Care Home packet was provided to and reviewed with applicants. Licensing information sheet regarding the Department's website: www.ccld.ca.gov to obtain forms and regulations CCR, Title 22 Facility Evaluation Report dated 03/09/2018 to be continued on next page: (This is an amended report delivered on 12/19/2019 signed by licensees' assistant Amalia Alejandro)

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (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)

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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: RECINOS, BLANCA & JOSE	FACILITY NUMBER: 434415257
	VISIT DATE: 03/09/2018

NARRATIVE

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Facility Evaluation Report dated 03/09/2018 to be continued from previous page: Page 3

A Provisional Large Family Child Care Home License will be approved pending on the following:
1. Amalia Alejandor's TB clearance. (Amalia Alejandro resides in the home.)
2. A revised application indicating the correct days and hours of operation.
3. A revised outdoor facility sketch depicting the fences and the bathroom in the detached
garage.
4. Proof of the dogs' vaccinations.
5. Payment of annual fee due for license #434415257.

Applicants understands they cannot operate the Large Family Child Care Home without the Provisional License. Applicants state that currently they are only caring for one child from one family. Applicants understand that the Provisional License will expire in 90 days from the date it is approved. Applicants understand that their certifications for Health and Safety including one hour of nutrition training must be received within the 90 days of the Provisional License before a regular Large Family Child Care Home license can be approved and issued.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2018

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2018

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: RECINOS, BLANCA & JOSE	FACILITY NUMBER: 434415257
	VISIT DATE: 03/09/2018

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Facility Evaluation Report dated 03/09/2018 to be continued from previous page: Page 2

was also provided. LPA reminded applicants of the applicable $100 civil penalty per person per day, a maximum of $500 per person (if cited again within 12 months maximum of $3,000 per person) for those adults who have not received fingerprint clearances, are not associated to the license that come in contact with or provide care and supervision to the children. Applicants were advised that smoking, baby walkers, bouncers, excersaucers and other similar items are not allowed. The following was discussed: isolation of sick children; supervision of children; capacity options; requirements for reporting suspected child abuse; unusual incident/injuries; fire drills practise at least twice a year and documented. LPA also discussed the requirements of AB 633 to applicant and provided applicant the fact sheet and a copy of Acknowledgement of receipt of Licensing Reports (LIC 9224). Zero Tolerance with immediate $500 civil penalty, ongoing $100 per violation per day until the violation(s) is corrected, also explained to applicants. SB792 Immunization Requirements was also discussed.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

A review of staff records during today's visit indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. . LPA also reminded applicants of the applicable civil penalties for those adults who have not received fingerprint clearance, 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. Applicants understand upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensee shall immediately removes the individual and prevents them from returning to the home or having contact with children in care.

Facility Evaluation Report dated 03/09/2018 to be continued on next page:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2018

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2018

LIC809 (FAS) - (06/04)

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