434415486-8-24-2021-07-CC-FCJO-C67T4R-20210824142422

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415486
Report Date: 08/24/2021
Date Signed: 08/24/2021 02:24:26 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:	CETINA DE NOVOA, CORINA		FACILITY NUMBER:	434415486
ADMINISTRATOR:	CETINA DE NOVOA, CORINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(669) 208-5693
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY:	14	CENSUS: 12	DATE:	08/24/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Corina Cetina de Novoa		TIME COMPLETED:	02:30 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) Fermin Campos-Jaramillo conducted an unannounced one year required inspection to the home today. LPA met with Corina Cetina, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM. The adults that reside in the home are the Licensee, her sister Carmen, and her helper Miryam (present today). Present in today's inspection were 12 children in care, included 9 preschool age, and 3 infants. Licensee's helper Miryam was present and providing care to the children present. Licensee's certifications for CPR and First Aid are current and will expire on 11/05/22 for licensee and on 10/17/22 for helper Miryam. LPA toured the indoor areas of the home during today's inspection. LPA obtained a copy of the Child Care Facility Roster during today's inspection and it is current. LPA reviewed six children's files and observed that parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification and emergency information forms are in each file. LPA reviewed the Fire/Disaster drill log during today's visit and it is current. Last fire drill was documented on 7/20/21. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas in the home are the two bedrooms, one bathroom, the kitchen, and the attached garage. LPA observed there are no stairs in the home. LPA observed the back yard is fenced. Licensee is currently using the back yard for child care. Off limits areas outside the home: The right and the left side yards. A observed a fully charged 2A10BC fire extinguisher, a working smoke and carbon monoxide detectors and no bodies of water. The Licensee states that she does not have any weapons in the home. LPA observed and reminded licensee that detergents, cleaning compounds, medications, and other similar items shall be always inaccessible to children. LPA observed the licensee and her helper have proof of immunization for measles, and pertussis and the opt out form for influenza in file according with the SB792. ******************************Report dated 8/24/2021 continues on page 2.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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: CETINA DE NOVOA, CORINA	FACILITY NUMBER: 434415486
	VISIT DATE: 08/24/2021

NARRATIVE

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Report dated 8/24/21 continues from page 1.

A review of staff records on 8/23/21 indicates that all adults residents, staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded 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 Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home, and licensee understands that ratio (age of the children) must be observed. Licensee understands that a helper must be present whenever there are more than 8 children in care. The Licensee states that she does not transports children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.
Department website: www.ccld.ca.gov provided to Licensee.

LPA discussed the requirements of AB 633 with the Licensee. LPA also discussed "zero tolerance" related regulations with the Licensee. LPA observed that licensee and her helper Miryam have completed the Mandated Reporter training on 11/13/2020 and 08/14/2021 respectively. Licensee understands that the training is mandatory for all the adults in contact with children and the training shall be renewed every two years. LPA provided Licensee with the website address for more information on the training: www.mandatedreporterca.com
LPA reviewed with licensee the new regulations on Safe sleep for infant children, and provided licensee with form LIC9227. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.
LPA provided licensee with the Lead Poisoning Facts sheet.

No deficiencies were cited during the inspection. Licensee rights was printed and given to Licensee. Exit interview and inspection was conducted with licensee in Spanish.
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: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

LIC809 (FAS) - (06/04)

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