434416762-2-25-2022-07-CC-SYIP-CBYSJB-20220225125451

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416762
Report Date: 02/25/2022
Date Signed: 02/25/2022 12:54:55 PM

Document Has Been Signed on 02/25/2022 12:54 PM - It Cannot Be Edited

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:	REYNOSO, ANA KARINA		FACILITY NUMBER:	434416762
ADMINISTRATOR:	REYNOSO, ANA KARINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 843-8923
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 0	DATE:	02/25/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Ana Karina Reynoso		TIME COMPLETED:	01:00 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 Analyst (LPA) Samantha Yip conducted an announced Pre-licensing inspection. LPA met with Applicant Ana Karina Reynoso and explained the reason for the inspection. The purpose of this inspection is Applicant applied for a change of location. Applicant is currently licensed on 26 Lusitano Way, Gilroy 95020. A fire clearance was granted on 02/22/2022. Licensee rents the home. A copy of the lease agreement was obtained during today's inspection. There is board to post required postings. There is working phone. Applicant stated that she does have daycare insurance and understands that parents need to sign the Affidavit regarding Liability Insurance if she does not have any. The hours of operation are Monday through Sunday 6AM to 5AM. LPA toured the inside and outside of the home. The off-limit areas inside of the home are Bedroom 2, Bedroom 3, Bedroom 4, and the laundry area. Applicant plans on using Bedroom 1 as a napping room. Applicant understands that the door cannot be closed when infants are sleeping. There is a fireplace in the home, which is barricaded. Cleaning supplies, disinfectant, and other items that are dangerous to children were inaccessible. There are toys and equipment for children. There are cots and cribs for the children. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Applicant stated that there are no weapons, such as firearms, stored in the home. The backyard is used and is fenced. The off-limit area outside of the home is the right side of the yard and the two sheds. LPA observed that the wooden platform the shed is sitting on is starting to warp. Applicant nailed a rug to the wooden platform to ensure that no wood starts to come up. There is uncovered garage on the left side of the home, which the Applicant does not have access to. There were no bodies of water observed during today's inspection. ---------------------------continues on 809 dated 02/25/2022 page 2-----------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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: REYNOSO, ANA KARINA	FACILITY NUMBER: 434416762
	VISIT DATE: 02/25/2022

NARRATIVE

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LPA discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicants of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Applicant plans on transporting children and understands that children cannot be left alone and unattended in parked vehicles. Car Seat Law was discussed and provided.

Applicant does not plan on providing Incidental Medical Services (IMS). 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

LPA reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. COVID guidelines and posters were provided and discussed with Applicants.

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SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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: REYNOSO, ANA KARINA	FACILITY NUMBER: 434416762
	VISIT DATE: 02/25/2022

NARRATIVE

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The adults living in the home 18 years and older are Applicant, her spouse, and her daughter. All adults have cleared fingerprints and TB clearance. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

An updated LIC 279 and signed LIC 508 for her spouse and her daughter were obtained during today's inspection.

Exit interview conducted and report was reviewed with the Applicant Ana Karina Reynoso. Applicant was advised that a license for a Large Family Child Care Home will be granted and issued upon review and approval of Licensing Program Manager. Applicant understands that she cannot start operating until she is licensed and that she needs to live in the home to be license.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

LIC809 (FAS) - (06/04)

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