434415607-6-22-2021-07-CC-JCRZ-C48QDV-20210622120522

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415607
Report Date: 06/22/2021
Date Signed: 06/22/2021 12:05:52 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:	GALVAN, ELIZABETH		FACILITY NUMBER:	434415607
ADMINISTRATOR:	GALVAN, ELIZABETH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(669) 300-7875
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	14	CENSUS: 6	DATE:	06/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Patricia Galvan		TIME COMPLETED:	12:00 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) Janette Cruz and Mel Matos conducted an unannounced Required – 1 year annual inspection. LPAs were granted access to the home by the Licensee by phone and she gave permission to her mother and sister (adult assistants) to assist with the inspection in Licensee's absence. LPAs also observed six children (2 infants and 4 preschool), the Licensee's mother/adult assistant, Patricia Galvan, Licensee's sister/adult assistant, Daisy Galvan and Licensee's minor brother (13 year old) were in the home during today's inspection. The day care was operating within the capacity and ratio requirements of the License during today's inspection. LPAs observed the required postings, including the facility license, near the front entrance to the home. The home has a working telephone (669) 300-7875. Days and hours of operation are Monday - Friday from 7:00 AM to 5:00 PM. The Licensee, Licensee's father (Apolonio Galvan), Licensee's mother (Patricia Malagon), and Licensee's sister (Daisy Galvan) also live in the home. The Licensee's and her mother's CPR and First Aid are current and expire in 01/04/2022. Licensee's sister's CPR and First Aids are current and expires on 06/27/22. LPAs reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on 12/29/20. The Licensee and Licensee's mother and Licensee's sister have the required vaccinations (MMR and Tdap). Licensee's mother was advised to submit proof of flu vaccination or statement opting out for flu vaccination for the Licensee and two adult assistants. The Licensee has current Mandated Reporter Training for Child Care Workers on file (exp: 11/19/21). Licensee's adult assistant's Mandated Reporter Training For Child Care Workers are also current (mother exp: 1/4/22 and sister exp: 06/23/22). LPAs reviewed six children's files and observed current and updated Identification and Emergency Information (LIC 700) and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. Patricia states that a child will be isolated in the living room area if needed to because of illness or communicable disease. Safe sleep updated: LPAs discussed the new “Safe Sleep” regulations with Patricia and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to her. REPORT CONTINUED ON FOLLOWING PAGE #2 - REPORT DATED 06/22/2021):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

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: GALVAN, ELIZABETH	FACILITY NUMBER: 434415607
	VISIT DATE: 06/22/2021

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 06/22/2021):
LPAs reminded Patricia that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.

LPAs toured the indoor and outdoor areas of the home during today's inspection. LPAs observed a trampoline in the backyard and advised Patricia that trampoline manufacturer instructions must be followed and children must always be supervised when using the trampoline. LPAs also observed a play structure in the backyard that is safe and secure to the ground. LPAs recommended that more soft padding be added the area surrounding the play structure. LPAs observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. There are no stairs inside the home. There is a barricaded fireplace unit in the living room area of the home. LPAs observed a wall heater in the hallway area of the home that is currently not barricaded. LPAs advised Patricia that wall heater must be barricaded and Licensee must submit a photo that wall heater has been barricaded. Off limit areas inside the home: three bedrooms, one bathroom, and attached garage. Off limit areas outside the home: locked storage and left side area of the backyard.

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

A review of staff records on June 22, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPAs also reminded Patricia 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.
REPORT CONTINUED ON FOLLOWING PAGE #3 - REPORT DATED 06/22/2021):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

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: GALVAN, ELIZABETH	FACILITY NUMBER: 434415607
	VISIT DATE: 06/22/2021

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 06/22/2021):
Supervision of children was discussed with Patricia and she understands that the Licensee must be present in the home during day care hours (minimum 80 % of the operating hours of the day care) 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 14 children in the home at any time without a fully qualified adult present. Patricia states that the day care does not transport any day care children. Patricia understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

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.

LPAs conducted an exit interview with Patricia, Licensee's mother/adult assistant and she agreed to have the following items submitted to LPA Cruz by Friday July 2, 2021:

1) Proof of flu vaccination or statement opting out for flu vaccination for the Licensee and two adult assistants.
2) Picture verifying that the wall heater, located in the hallway area, is barricaded.
3) Pictures verifying that additional soft padding has been added to the area surrounding the play structure in the backyard.

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

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

LIC809 (FAS) - (06/04)

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