444416379-4-11-2024-07-CC-JBOT-D48R3S-20240411124024

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444416379
Report Date: 04/11/2024
Date Signed: 04/11/2024 12:40:32 PM

Document Has Been Signed on 04/11/2024 12:40 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	BALLA, GUSTAVO AND SARA		FACILITY NUMBER:	444416379
ADMINISTRATOR:	BALLA, GUSTAVO AND SARA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 588-4225
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95060
CAPACITY:	14	CENSUS: 11	DATE:	04/11/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:16 AM
MET WITH:	Sara Balla		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) Jessica Bongardt met with Sara Balla for an unannounced Required Annual Inspection. LPA was granted access to the day-care by the Licensee. The day-care is located at the bottom part of the home, children have no access to the home. LPA also observed eleven children in the day-care during today's inspection. Licensee was operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the day-care. Days and hours of operation are Monday to Friday 8:30 AM to 1:00PM. The adults residing in the home is the Licensee her husband, and three minor children. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on 03/28/2024. Licensees state that they do have liability insurance for the day care. Licensee has current CPR and First Aid certifications (expiration:03/26/2026). Licensee has the required vaccines (MMR, Tdap, & flu) and is current with her Mandated Reporter Training for Child Care Workers (expires:03/28/2026). LPA reviewed four children's files and the files were complete with the required forms. LPA also reviewed two staff files and they were complete with required forms. Licensees state that a child will be isolated from the other children on a couch in the large classroom of the day-care if necessary due to illness or communicable disease until a parent/guardian is able to pick them up. LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (831) 588-4225. The day-care is clean, orderly, (including heating/air conditioning/ventilation), and safe for the day care children. There are safe & age-appropriate toys, play equipment, and materials for the children in the day-care. There are stairs leading to the upstairs part of the house which are blocked off and are made inaccessible to the children in care. There is a fireplace which is barricaded so the children do not have access to it.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510)-566-5850
LICENSING EVALUATOR NAME: Jessica Bongardt	TELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BALLA, GUSTAVO AND SARA	FACILITY NUMBER: 444416379
	VISIT DATE: 04/11/2024

NARRATIVE

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Off limit areas inside the day-care: the door to the stairs leading to the house. Off limit area outside the home: none

LPA observed a fully charged (3-A-40-BC) fire extinguisher, working smoke/carbon monoxide detectors, and fenced backyard. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. There are no bodies of water located at the day-care and Licensee states there are no weapons located at the facility.

Licensee states that she does not administer any medications to the day-care children. Licensee states that she does not provide any food to the day-care children, all food is brought from home. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored. Licensee has a first aid kit in the home which includes a touch-less thermometer. Licensee states that nobody smokes, and she understands that smoking is prohibited in the day-care.

The licensee understands that children's personal rights should not be violated, including no unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threats, mental abuse, or other actions of a punitive nature.

Supervision of children was discussed with the Licensee, and she understands that she must be present in the day-care during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity/ratio options and she understands that she cannot have more than 14 children present in the day-care. Licensee states that she does not transport any day care children. Licensee 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.

Licensee was reminded that all adults 18 and over living or working in the day-care, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days/$3000.00 per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Belinda Devall	TELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Jessica Bongardt	TELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BALLA, GUSTAVO AND SARA	FACILITY NUMBER: 444416379
	VISIT DATE: 04/11/2024

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed Licensee 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.

The licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with the Licensee, Sara Balla. No deficiencies issued during today's inspection.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Belinda Devall	TELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Jessica Bongardt	TELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

LIC809 (FAS) - (06/04)

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