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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415403
Report Date: 02/20/2020
Date Signed: 02/21/2020 11:51:48 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ALLER, NAOMIFACILITY NUMBER:
434415403
ADMINISTRATOR:ALLER, NAOMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 772-7777
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:14CENSUS: 13DATE:
02/20/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:NAOMI ALLERTIME COMPLETED:
12:30 PM
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On 02/20/2019, Licensing Program Analyst Manel Estoesta, met with licensee NAOMI ALLER for an UNANNOUNCED REQUIRED 1 YEAR INSPECTION. Present for this visit were 3 INFANT, 9 PRESCHOOL CHILDREN, 1 KINDERGARTEN ENROLLED CHILD and FINGER PRINT CLEARED ASSISTANT PROVIDER Divina Garcia. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from Monday through Friday 08:30 AM to 06:00 PM

The home is a single story. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the day care room, hallway bathroom and backyard. The BACKYARD play area is completely fenced. Parents use the Right Side Yard Gate for entrance and a code needed for access. The OFF LIMIT AREAS are all bedrooms, living room, dining room, kitchen, and the garage which will be inaccessible by closed and or locked doors and or a fence with visual supervision. The ISOLATION AREA will be the day care room. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today.

The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector and working telephone. The licensee and assistant provider have current CPR and First Aid certificate. The licensee will complete Mandated Reporter Training online when it is available in Tagalog/Filipino. The fireplace is screened to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year. Licensee stated that she does transport children at this time.

See 809-C for continuance

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ALLER, NAOMI
FACILITY NUMBER: 434415403
VISIT DATE: 02/20/2020
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Individual Medical Services (IMS) policy was discussed. 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

LPA Estoesta provided a copy of New Safe Sleep Brochure, Lead Poisoning Facts Flyer and California Child Safety Seat Law to the licensee.



The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list


There are no deficiencies cited. This report shall remain on file for 3 years. A copy of the appeal rights was provided. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
LIC809 (FAS) - (06/04)
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