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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406186
Report Date: 09/10/2021
Date Signed: 09/10/2021 12:37:34 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:SANTOS, CELESTE & DONALDFACILITY NUMBER:
444406186
ADMINISTRATOR:SANTOS, CELESTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 477-0348
CITY:SOQUELSTATE: CAZIP CODE:
95073
CAPACITY:14CENSUS: 6DATE:
09/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Celeste & Donald SantosTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Goodell met with licensee, Celeste Santos, for the purpose of an Unannounced Annual Random Inspection. Hours of operation are Monday- Friday, 7:00am- 5:30pm. During inspection LPA, observed 5 child present with licensee Celeste and assistant in the outdoor area. LPA also observed licensee Donald present with 2 children in the indoor infant area. All individuals subject to criminal background review have obtained a criminal record clearance.

Inspection was conducted in all areas accessible to children. Off-limits areas include includes the entire second floor which has 1 restroom, 2 bedrooms, a living room, a family room, an office room, and a kitchen. LPA verified phone number and email are current. LPA also observed a 3A40BC fire extinguisher, smoke and carbon monoxide detectors. No weapons in the home. LPA observed poisons are locked in area inaccessible to children. LPA observed cleaning compounds, medication and knives are stored inaccessible to children. LPA observed outdoor area is fully fenced. Licensee acknowledged that 100% supervision is required in unfenced area. Child records was reviewed. LPA also observed fire drill log and children roster maintained. Preventative health training, current pediatric CPR and first aid certification was verified and expires 3/2022.

The Effects of Lead Exposure brochure posted. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, forms, self-assessment guides, legislation and regulation information. PIN 21-08-CCP and COVID-19 UPDATE Guidance: Child Care Programs and Providers were discussed.
Report continues on LIC809-C
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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: SANTOS, CELESTE & DONALD
FACILITY NUMBER: 444406186
VISIT DATE: 09/10/2021
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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

No deficiencies cited. LPA reviewed report with the licensee and provided copies. An exist interview was conducted. The Notice of Site Visit issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC809 (FAS) - (06/04)
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