434415567-8-22-2019-07-CC-JTSE-BFAV4J-20190822160624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415567
Report Date: 08/22/2019
Date Signed: 08/22/2019 04:06:37 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:	ISAZA, SANDRA		FACILITY NUMBER:	434415567
ADMINISTRATOR:	ISAZA, SANDRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 595-1808
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	14	CENSUS: 0	DATE:	08/22/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Sandra Isaza		TIME COMPLETED:	04:15 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 Analysts (LPAs) Janet Tse and Susy Cervantes met with applicant Sandra Isaza for an announced pre-licensing inspection to the home today. The adults that reside in the home are the Applicant and her husband with two children ages 11 1/2 and 9. Days and hours of operation will be Monday to Friday from 7:30am to 5:30pm. Applicant has completed her Preventative Health and Safety Child Care Training and a copy of the certification is in file. Applicant's CPR and First Aid certifications are current and expire on 07/22/2020. Applicant rents the home and the Owner/Landlord Notification form (LIC 9151) is on file. LPA reminded the Applicant that she cannot care for more than 12 children unless she obtains the Owner/Landlord consent for day care. Applicant does not have liability insurance and will issue affidavit regarding liability insurance for FCCH. LPAs toured the indoor and outdoor areas during today's visit. There are no stairs in the home. Off limit areas inside the home: master bedroom, master bathroom, two bedrooms, kitchen, and the garage. One of the four bedrooms is used for napping only. LPAs observed a fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detectors. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. LPAs observed a blocked fireplace. LPAs reminded Applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. The backyard is fenced. LPAs observed no bodies of water. Off limit areas outdoor: Areas beyond the safety fences (resinets) which consists of the side yards, a lemon tree, and half of the backyard. Applicant states that there are no weapons in the home. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 08/21/2019 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPAs reminded Applicant of the applicable civil penalties for those Facility Evaluation Report dated 08/22/2019 to be continued on next page: Pg 1

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

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: ISAZA, SANDRA	FACILITY NUMBER: 434415567
	VISIT DATE: 08/22/2019

NARRATIVE

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Facility Evaluation Report dated 08/22/2019 to be continued from previous page:

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.

Forms of discipline used by Applicant: talking to children and redirection. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

A Family Child Care Home packet with updated Licensing forms was provided to and reviewed with the Applicant. Department website: www. ccld.ca.gov provided to Applicant. Periodic information releases accessible by signing up at: www.myccl.ca.gov. Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

LPAs discussed the requirements of AB 633 with the Applicant and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Applicant understands the requirements. LPAs also discussed "zero tolerance" related regulations with the Applicant and advised her of the assessment of an immediate $500 civil penalty, and an ongoing $100 per day per violation continues until the violation(s) is corrected.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301

Facility Evaluation Report dated 08/22/2019 to be continued on next page: Pg 2

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

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: ISAZA, SANDRA	FACILITY NUMBER: 434415567
	VISIT DATE: 08/22/2019

NARRATIVE

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Facility Evaluation Report dated 08/22/2019 to be continued from previous page:

(voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

SB Immunization Requirements was discussed. Information for Safe Sleep was provided to Applicant. LPAs advised Applicant that written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians. LPAs discussed the Mandated Reporter AB1207 Compliant Child Care Training which is to be completed every two years. Website to complete training: https://mandatedreporterca.com. Applicant's primary language is Spanish and is currently exempt from the training.

LPAs conducted an exit interview with the Applicant and advised her that a large Family Child Care Home license is approved effective today, 08/22/2019.

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SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

LIC809 (FAS) - (06/04)

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