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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416384
Report Date: 07/26/2019
Date Signed: 07/26/2019 02:51:41 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:CAIMOL, ANISIAFACILITY NUMBER:
434416384
ADMINISTRATOR:CAIMOL, ANISIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 788-6723
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:14CENSUS: 0DATE:
07/26/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Anisia CaimolTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Stephanie Rangel met with Applicant, Anisia Caimol, and conducted an announced prelicensing inspection. The adults that reside in the home are: applicant, and her husband. Applicant's eleven year old child also lives in the home.

Days and hours of operation will be Monday - Friday from 9:00 AM to 6:00 PM. Applicant has completed her Preventative Health and Safety Child Care Training including Nutrition. Applicant's CPR and First Aid certifications are current with an expiration date of May 12, 2020. Applicant leases the home and lease agreement was provided during today's inspection. Applicant states that she will use the Affidavit Regarding Liability Insurance form to inform parents that she does not carry daycare insurance.

LPA toured the indoor and outdoor areas. The home is clean and orderly. Off limit areas in the home: all four bedrooms, master bathroom, hall bathroom, kitchen and garage. Off limit areas outside the home are two storage sheds. LPA observed a fully charged 2A10BC fire extinguisher, working smoke detector, functioning carbon monoxide detector, barricaded fireplace, fenced backyard, and no bodies of water. LPA observed sufficient materials, toys, and play equipment for the daycare children. Per Applicant, there are no weapons in the home. LPA reminded Applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. Property Owner/Landlord Consent (LIC 9149) and Property Owner/Landlord Notification (LIC 9151) was received today.

Applicant states that she will talk to children and parents and redirection as forms of discipline. Applicant understands that children's personal rights should not be violated; including no corporal punishment.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 07/26/19):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CAIMOL, ANISIA
FACILITY NUMBER: 434416384
VISIT DATE: 07/26/2019
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 07/26/19):
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 review of staff records during today's inspection 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 reminded Applicant 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.

A Family Child Care Home packet with updated Licensing forms was provided to and reviewed with the Applicant. LPA discussed AB 633, car seat law, healthy beverages in child care, and zero tolerance violations with Applicant. Licensing forms, Title 22 regulations, can be obtained through the internet at ww.ccld.ca.gov. Mandated Reporter Training can be accessed at www.mandatedreporterca.com.

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 (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.

Effect of Lead Exposure handout dated 1/20/19 given during today’s inspection. Per assembly bill (AB 2370), Licensee understands that written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians.


As a result of this inspection, a license for a large family child care home is granted upon management's approval and the following items are received:
Proof that medications, sharp objects and cleaning compounds viewed in the kitchen are stored inaccessible to children.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019
LIC809 (FAS) - (06/04)
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