434415535-11-26-2019-07-CC-MSMS-BJAUAL-20191126142456

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415535
Report Date: 11/26/2019
Date Signed: 11/26/2019 02:25:02 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:	BANUELOS, YADIRA AND CRISTANCHO, GLORIA		FACILITY NUMBER:	434415535
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	11/26/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Yadira Banuelos & Gloria Cristancho		TIME COMPLETED:	02:40 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) Mel Matos met with Yadira Banuelos, Licensee, for unannounced annual/random inspection. LPA notes that Yadira also submitted paperwork & payment, including the Application for a Family Child Care Home (LIC 279) requesting an increase in the licensed capacity and removal of Gloria Cristancho, Yadira's mother-in-law, from the current license. Yadira has been licensed since March 14, 2019 and also submitted written proof of experience thus meeting the one year experience requirement for the large Family Child Care Home (FCCH) license. LPA also observed Yadira's mother-in-law (Gloria Cristancho), Yadira's father-in-law (Marcos Bautista), three day care children (2 infants & 1 preschool), and Licensee's two year old daughter in the home during today's inspection. Days and hours of operation are Monday - Friday from 7:30 AM to 5:30 PM. The adults that reside in the home are: Yadira (Licensee), Yadira's spouse, Gloria's spouse (Yadira's father-in-law), and Yadira's adult sister. The Licensee also has a second minor child, age 11 years, residing in the home. Yadira's CPR & First Aid certifications are current and expire on October 20, 2020. Gloria's CPR & First Aid certifications are current and expire on January 28, 2021. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on July 22, 2019. LPA reviewed four children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. Yadira and Gloria have completed the Mandated Reporter Training for Child Care Workers and copies of the certificates of completion are on file. LPA reminded Yadira that the Mandated Reporter Training for Child Care Workers must be renewed every two years. LPA toured the indoor and outdoor areas of the home during today's inspection. The home is two story and LPA observed barricaded stairs during today's inspection. Off limit areas inside the home (upstairs): entire upstairs - master bedroom, 4 bedrooms, and 2 bathrooms. Off limit areas inside the home (downstairs): attached garage, barricaded fireplace, and 8 drawers & 9 cabinet doors in the kitchen area. There are no wall heater units inside the home. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 11/26/2019):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

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: BANUELOS, YADIRA AND CRISTANCHO, GLORIA	FACILITY NUMBER: 434415535
	VISIT DATE: 11/26/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 11/26/2019):

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.

A review of staff records on November 26, 2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Yadira 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 Yadira 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 8 children in the home at any time currently and no more than 14 children with at least two qualified adults (once she is approved from the large FCCH license). The Licensee states that does not transport children in her vehicle.

The Licensee states that she anticipates getting a fire inspection from the Sunnyvale Department of Public Safety within 1-2 weeks.

Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates.

No deficiencies issued during today's inspection.

LPA conducted an exit interview with Yadira and advised her that a large Family Child Care Home License will be approved upon receipt of an approved fire clearance from the Sunnyvale Department of Public Safety.

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

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

LIC809 (FAS) - (06/04)

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