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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415486
Report Date: 09/13/2023
Date Signed: 09/13/2023 12:48:37 PM


Document Has Been Signed on 09/13/2023 12:48 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:CETINA DE NOVOA, CORINAFACILITY NUMBER:
434415486
ADMINISTRATOR:CETINA DE NOVOA, CORINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 208-5693
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:14CENSUS: 11DATE:
09/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Corina Cetina De NovoaTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Teodoro Trujillo and Mel Matos met with Corina Cetina De Novoa, Licensee, for an unannounced case management inspection. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM. The Licensee states that she is the only adult residing in the home. Present were the Licensee and her two assistants Ayda Leon and Liliana Tumay with 12 day care children in care (8 preschool & 4 infants).

LPAs reviewed 12 children's files, infant sleep logs for four infant children, and took pictures of the Child Care Facility Roster. The Child Care Facility Roster was missing dates children left and thus not current. The Licensee did not have infant sleep logs for the four infants present during today's inspection.

Two Type B Deficiencies are cited today on the attached page (LIC 809-D) as result of today's inspection. Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.
Exit interview conducted and report was reviewed with the Licensee, Corina Cetina De Novoa.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
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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Document is an Amendment of Original Document on 09/14/2023 03:11 PM

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/14/2023
Section Cited
CCR
102417(g)(8)

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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.
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Licensee will submit an updated Facility Roster to the San Jose Regional Office by close of business 09/14/23.
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Based on observation, interview and record review, the licensee did not comply with the section cited above in Roster was not updated, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
09/22/2023
Section Cited
CCR102425(j)(2)(D)

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INFANT SAFE SLEEP
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:
a. Date.
b. Infant’s name.
c. Time of each 15-minute check.
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LIcensee will submit copies of 15 minute safe sleep logs to the San Jose Regional Office by Close of business 09/22/23.
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Based on observation, interview and record review, the licensee did not comply with the section cited above in sleep logs are missing for all 4 infant children in care during site visit,which poses/posed a potential health, safety or personal rights risk to persons 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: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2