434415415-6-9-2022-07-CC-PHEZ-CF8QG9-20220609120910

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415415
Report Date: 06/09/2022
Date Signed: 06/09/2022 12:09:42 PM

Document Has Been Signed on 06/09/2022 12:09 PM - It Cannot Be Edited

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:	RODRIGUEZ, APRIL		FACILITY NUMBER:	434415415
ADMINISTRATOR:	APRIL RODRIGUEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 648-9820
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY:	14	CENSUS: 6	DATE:	06/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	April Rodriguez		TIME COMPLETED:	12:12 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) Pete Hernandez conducted an unannounced Required 1 Year inspection. LPA met with April Rodriguez, Licensee, and explained the nature of today's visit to her. LPA also observed children in care ( 5 preschoolers, and 1 infant ) in the home during today's inspection. The adults that reside in the home are the Licensee, her spouse, with her minor son. Days and hours of operation are Monday - Friday from 7:00 AM to 7:00 PM. LPA toured the on limit indoor and outdoor areas during today's inspection, including the nap room, living/ play area, kitchen, activity room, both bathrooms, and the outside deck play area, and the backyard. LPA also inspected the off limit areas indoors and outdoors, which were locked and inaccessible to the children in care. Off- limit areas inside and outside the home per the San Jose Fire clearance are: the three bedrooms (2, 3. 4) and the detached garage converted into a living space where the brother in law resides. (Brother in law has been fingerprinted, cleared and associated to the license.) Licensee acknowledged that children may never enter these off-limit areas. All off limit areas have locked doors. LPA did not observe any bodies of water on the property. The back yard was recently upgraded fir the children with running space, artificial turf, climbing structures and pavers. Licensee states that there are no weapons in the home. LPA Hernandez observed a fully operational 3A40BC fire extinguisher. LPA also observed operating carbon monoxide detector and smoke alarm with a fire pull station. Cleaning products, toxic agents, medications, and sharp objects are inaccessible to children and kept in the locked laundry room. LPA reminded Licensee that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 06//09/2022

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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: RODRIGUEZ, APRIL	FACILITY NUMBER: 434415415
	VISIT DATE: 06/09/2022

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 6/9/2022):

LPA informed 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.

Licensee does not have an IMS. 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

The Licensee states that she does not transport children and understands that children cannot be left in parked vehicles unattended at any time. Licensee understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick child, requirements for reporting suspected child abuse, unusual incidents/injuries, heat-related illnesses, and requirements for assistant/substitute were also discussed.

Supervision of children was discussed with the Licensee. Licensee understands that she must be present in the home at least 80 percent of the hours the day care is in operation and ensure that the children are supervised at all times. The Licensee understands her capacity options. The Licensee states that she does not transport children and understands that children cannot be left in parked vehicles unattended at any time. Licensee understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick child, requirements for reporting suspected child abuse, unusual incidents/injuries, heat-related illnesses, and requirements for assistant/substitute were also discussed.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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: RODRIGUEZ, APRIL	FACILITY NUMBER: 434415415
	VISIT DATE: 06/09/2022

NARRATIVE

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LPA went over Regulation 102425(j) and (j)(2)(D) regarding infant care and LIC 9227 (Infant Sleeping Plan). LPA Provided a copy. The provider shall supervise infants while they are sleeping.

LPA reviewed the files of 6 children and 1 Staff. Licensee is very organized and all required documentation was current and in the file.

Last fire drill log entry was on 6/1/22. Licensee understand these need to be done every 6 months at minimum.

Licensee's CPR and First Aid Card is current and expires 2/13/24

Licensee provided a copy of her last children's roster to the LPA.

LPA observed all required postings on the wall next to the front door.

Type A language: Upon the issuance of Type A citations, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. A copy of this report was discussed and left with the Licensee, April Rodriguez, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC809 (FAS) - (06/04)

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