434415567-7-7-2021-07-CC-JTSE-C4PTZ4-20210707150943

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415567
Report Date: 07/07/2021
Date Signed: 07/07/2021 03:09:56 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: 7	DATE:	07/07/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Sandra Isaza		TIME COMPLETED:	03:15 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	(1)LPA Janet Tse met with licensee Sandra Isaza for a Required - 1 Year inspection. Present were seven children with four infants. Present were also Licensee's assistant (AMA) and Licensee's minor children. Adults living in the home are Licensee and her husband with two children ages 13 1/2 and 11. Days and hours of operation are Monday to Friday, 7:30am to 5:30pm. LPA toured the indoor and outdoor of the home. LPA observed a blocked fireplace and no wall heaters. LPA observed no stairs inside the home. Off limits indoor: master bedroom, master bathroom, two bedrooms, kitchen, and the garage. One of the four bedrooms is used for napping only. There are no bodies of water. Licensee stated there is no firearms/weapons in the home. Medicines, poisons and cleaning supplies are inaccessible to the children. Storage areas for poisons are locked. Backyard is fenced. Off limits outdoor: both side yards. LPA reminded licensee that she can only have 14 children according to her license. Licensee also understands her ratio and capacity options. Fire extinguisher is size 3A40BC and filled. Smoke and carbon monoxide detectors are operable. Home is clean and orderly with heating and ventilation for safety and comfort. LPA observed sufficient materials, toys, and play equipment for Facility Evaluation Report dated 07/07/2021 to be continued on next page: - Pg 1 of 4 -

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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: 07/07/2021

NARRATIVE

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Facility Evaluation Report dated 07/07/2021 to be continued from previous page (Pg 1):
the day care children. LPA observed Licensee is providing safe, healthful, and comfortable accommodations, furnishings, and equipment. Telephone is in working order.

Children were supervised on the visit and LPA went over substitute options. Licensee also understands that when a child shows signs of illness or communicable disease, he/she shall be separated from other children. LPA also discussed if licensee transports children, they are never to be left in parked vehicles.

A listing of staff criminal record clearances associated to this facility in Guardian system on 07/02/2021 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. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100 per person per day, minimum of $100 to a maximum of $500 per person for an initial violation, and a minimum of $100 to a maximum of $3000 per person for any subsequent violation within a 12-month period.

LPA reviewed seven children's files. LPA observed each child’s record has a copy of the emergency information card that contains all of the information specified by
Facility Evaluation Report dated 07/07/2021 to be continued on next page: - Pg 2 of 4 -

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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: 07/07/2021

NARRATIVE

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Facility Evaluation Report dated 07/07/2021 to be continued from previous page (Pg 2):
regulation. LPA observed Licensee and her assistant have completed training on preventive health practices including the lead component, and both have current Pediatric CPR/1^st Aid expiring 11/17/2022 and 05/12/2023 respectively.

LPA discussed the immediate civil penalties for Zero Tolerance of $500, and an ongoing $100 per day per violation continues until the violation(s) is corrected. Licensee understands that when notified by the Department, Licensee shall comply with the removal of any person from the facility, who has specified convictions or for other reasons. LPA also discussed any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice.

LPA discussed the infant safe sleep policies, regulations, and requirements. LPA observed an LIC 9227 Individual Infant Sleeping Plan in the file of each infant up to 2 months of age. LPA observed documentation for infant sleep supervision which is maintained in each infant’s file includes date, infant’s name, and time of each 15 minutes check. Licensee also understands that car seats can only be used for transportation and shall not be used for sleeping.

AB792 Immunization Requirements was discussed. LPA observed the required immunization records for Licensee and her assistant were in file.

The Mandated Reporter AB1207 Compliant Child Care Training was also discussed. Website to complete training: https://mandatedreporterca.com. A link
Facility Evaluation Report dated 07/07/2021 to be continued on next page: - Pg 3 of 4 -

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: 07/07/2021

NARRATIVE

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Facility Evaluation Report dated 07/07/2021 to be continued from previous page (Pg 3):
to the alternate trainers approved to provide mandated reporter training: https://www.cdss.ca.gov/Portals/9/CCLD/CCP%20Documents/Approved%20Mandated%20Reporter%20Trainings.pdf. Licensee understands that the training is to be renewed every two years. LPA observed Licensee and her assistant completed the training on 05/24/2021 and 06/07/2021 respectively.

Website for provider resources: https://cdss.ca.gov/inforesources/Child-Care-Licensing. Periodic information releases accessible by signing up at: https://cdss.ca.gov/inforesources/community-care-licensing/subscribe.

No deficiency was cited. Notice of site visit was issued and must be posted for 30 days.
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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: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

LIC809 (FAS) - (06/04)

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