434415518-12-16-2019-07-CC-DMAC-BJWP6C-20191216100207

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415518
Report Date: 12/16/2019
Date Signed: 12/16/2019 10:02:12 AM

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:	FUENTES CANO, ANA		FACILITY NUMBER:	434415518
ADMINISTRATOR:	FUENTES CANO, ANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 981-7161
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95122
CAPACITY:	14	CENSUS: 6	DATE:	12/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:05 AM
MET WITH:	Fuentes Cano, Ana		TIME COMPLETED:	10:00 AM

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) Dung Mac met with Ana Fuentes Cano, Licensee, for an unannounced annual inspection. LPA observed one Assistant, Andrea Fuentes Cano, and five day care children, of whom were two infants, three preschoolers, and one schoolag during today's inspection. Days and hours of operation are: Monday-Friday 6:00am-6:00pm. LPA toured the home both inside and out. Off limits areas are the master bedroom and attached garage. LPA observed fireplace in living room is screened. LPA also observed another fire place in playroom is screened and blocked by a bookshelf. LPA observed a wall heater is barricaded. Front yard and backyard are fenced. Licensee stated that the front yard gate is closed when children play in front yard area. Sides of the home are off limits and gated. LPA observed storage shed and fenced off area next to it are locked. LPA observed that there are no bodies of water. LPA observed a fully charged fire extinguisher, working smoke detector and carbon monoxide. Licensee stated that there are no weapons or pets in the home. Cleaning products, toxic, medications, and sharp objects were inaccessible to children. The home is clean, orderly, and safe for the day care children. LPA observed sufficient materials, toys, and play equipment for the day care children. Licensee stated that she transports children. LPA reminded Licensee that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system. The last fire/disaster drill was conducted on 7/09/19. LPA reviewed the Child Care Facility Roster. Six children's files were reviewed and all were complete. Continued on Page #2

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019

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: FUENTES CANO, ANA	FACILITY NUMBER: 434415518
	VISIT DATE: 12/16/2019

NARRATIVE

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Licensee and Assistants' files were reviewed. Licensee and Assistants maintain records of immunization. Licensee's Pediatric CPR & First Aid certification expires 12/09/20. Licensee's Mandated Report training expires 10/11/20. Licensee was provided the Mandated Reporter Training website http://mandatedreporterca.com.
LPA reminded Licensee that the Mandated Reporter Training needs to be renewed every two years.

Adults who reside in the home are Licensee and spouse. They have Clearances for Tuberculosis, and Criminal Background and Child Abuse Index Checks. LPA 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.

Licensee stated she does not have any children in care who requires administration of medication. The facility is not providing Incidental Medical Services at this time. IMS was discussed. The following US Department of Justice resource was provided: http://www.ada.gov/childqanda.htm.

LPA provided a copy of the “Lead Poisoning Facts Information Flyer”, "Car Seat Law", and "Safe Sleep" Information to Licensee.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing updates and regulations.

No deficiency was cited today. An exit interview was conducted. Notice of Site Visit was given to Licensee and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019

LIC809 (FAS) - (06/04)

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