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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415486
Report Date: 12/11/2023
Date Signed: 12/12/2023 03:07:02 PM


Document Has Been Signed on 12/12/2023 03:07 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
SAN JOSE CC RO, 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: 10DATE:
12/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Corina Cetina De NovoaTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Teodoro Trujillo and Deanna Villagrana met with licensee Corina Cetina De Novoa for an unannounced case management visit. LPAs explained the nature of the visit. Present were licensee, licensee's assistant Liliana Tumay and eight day care children including two infants. Two additional infants arrived during the visit.

LPAs observed a infant being detained in a high chair while licensee tended to LPAs and assistant was outside with other children. LPA Villagrana observed licensee pick up a child by the wrist from a boppy chair. LPAs observed child 1 is missing signature on LIC700. Child 1, 3, and 10 are missing LIC282. Child 2 is missing LIC9227. Child 5 is missing LIC627. Child 1, 3, and 7 Safe Sleep log is not updated or does not have one. LPAs observed last fire drill was conducted 05/24/2023. Child 1 immunization records need to be updated. Child 2 is missing from roster. This is a repeat violation from 09/13/2023. A $250 repeat civil penalty is being assessed today. During the visit, interviews were conducted with parents. Information was obtained that assistant Beatrice Zapata was present in the home. Beatrice does not have criminal record clearance and associated to the facility. A $500 civil penalty is being assessed today. Licensee admitted Beatrice has been working in the home since 11/08/2023.
The following type A and B deficiencies were cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

LPAs Teodoro Trujillo and Deanna Villagrana informed licensee Corina Cetina De Novoa that this report dated 12/11/2023 document(s) 3 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

SUPERVISOR'S NAME: Susy CervantesTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CETINA DE NOVOA, CORINA
FACILITY NUMBER: 434415486
VISIT DATE: 12/11/2023
NARRATIVE
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Also, LPAs Teodoro Trujillo informed the licensee Corina Cetina de Novoa to provide a copy of this licensing report dated 12/11/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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: Susy CervantesTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/12/2023 03:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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: 12/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/12/2023
Section Cited
CCR
102423(a)(1)

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To be treated with dignity in his/her personal relationship with staff and other persons. This requirement was not met as evidenced by LPA Villagrana observed licensee pick up a child by the wrist from a boppy chair.
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Licensee will submit a statement stating she understands regulation and treat children with respect and pick them up in the correct manner.
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This poses an immediate risk to the Health, Safety or Personal Rights to children in care. LPAs observed a infant being detained in a high chair while licensee tended to LPAs and assistant was outside with other children.
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Type A
12/11/2023
Section Cited
CCR102423(a)(2)

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To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidenced by LPAs observed a infant being detained in a high chair while licensee tended to LPAs and assistant was outside with other children.
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Licensee removed child after LPA Villagrana addressed the situation. Licensee will submit a statement stating she understands high chairs are only used for feeding.
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This poses an immediate risk to the Health, Safety or Personal Rights to children 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: Susy CervantesTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2023
LIC809 (FAS) - (06/04)
Page: 3 of 8


Document Has Been Signed on 12/12/2023 03:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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: 12/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/12/2023
Section Cited
CCR
102370(d)(1)

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Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by Information was obtained that assistant Beatrice Zapata was present in the home. Beatrice does not have criminal record clearance and associated to the facility. A $500 civil penalty is being assessed today. Licensee admitted Beatrice has been working in the home since 11/08/2023.
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Licensee was informed Beatrice Zapata may not be present in the home until clearance is obtained.
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This poses an immediate risk to the Health, Safety or Personal Rights to children 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: Susy CervantesTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2023
LIC809 (FAS) - (06/04)
Page: 4 of 8


Document Has Been Signed on 12/12/2023 03:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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: 12/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/18/2023
Section Cited
CCR
102421(a)

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The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7).
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Licensee will submit LIC700 for child 1 to CCLD by POC date.
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This requirement was not met as evidenced by LPAs observed child 1 is missing signature on LIC700. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
12/18/2023
Section Cited
CCR102417(g)(1)

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An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
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Licensee will submit LIC627 for child 5 to CCLD by POC date.
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This requirement was not met as evidenced by Child 5 is missing LIC627. This poses a potential risk Health, Safety Personal Rights risk to children 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: Susy CervantesTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2023
LIC809 (FAS) - (06/04)
Page: 5 of 8


Document Has Been Signed on 12/12/2023 03:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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: 12/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/18/2023
Section Cited
CCR
102417(m)(3)

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A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.
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Licensee will submit LIC282 for child 1, 3 and 10 to CCLD by POC date.
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This requirement was not met as evidenced by Child 1, 3, and 10 are missing LIC282. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
12/18/2023
Section Cited
CCR102425(c)

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An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file.
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Licensee will submit LIC9227 for child 2 to CCLD by POC date.
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This requirement was not met as evidenced by Child 2 is missing LIC9227. This poses a potential risk Health, Safety Personal Rights risk to children 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: Susy CervantesTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2023
LIC809 (FAS) - (06/04)
Page: 6 of 8


Document Has Been Signed on 12/12/2023 03:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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: 12/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/18/2023
Section Cited
CCR
102417(g)(9)(A)

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Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement was not met as evidenced by LPAs observed last fire drill was conducted 05/24/2023.
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Licensee will submit an updated fire drill log to CCLD by POC date.
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This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
12/11/2023
Section Cited
CCR102417(g)(8)

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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 completed roster during visit. Deficiency cleared today.
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This requirement was not met as evidenced by Child 2 is missing from roster. This poses a potential risk Health, Safety Personal Rights risk to children 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: Susy CervantesTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2023
LIC809 (FAS) - (06/04)
Page: 7 of 8


Document Has Been Signed on 12/12/2023 03:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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: 12/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/18/2023
Section Cited
CCR
102425(j)(2)(D)

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Documentation shall be maintained in the infant’s file and be available to the Department for review. This requirement was not met as evidenced by Child 1, 3, and 7 Safe Sleep log is not updated or does not have one.
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Licensee will submit a statement stating she understands all infants must have a Safe Sleep log when in care.
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This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
12/18/2023
Section Cited
CCR102418(g)(1)

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This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.
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Licensee will submit updated immunizations for child 1 to CCLD by POC date.
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This requirement was not met as evidenced by Child 1 immunization records need to be updated. This poses a potential risk Health, Safety Personal Rights risk to children 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: Susy CervantesTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2023
LIC809 (FAS) - (06/04)
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