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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274413447
Report Date: 09/14/2022
Date Signed: 09/14/2022 01:30:14 PM

Document Has Been Signed on 09/14/2022 01:30 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:CABALLERO, JOSEFINAFACILITY NUMBER:
274413447
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 4DATE:
09/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Josefina CaballeroTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual inspection to the home today. LPA met with Josefina Caballero, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 5:00 AM to 8:00 PM, and Saturdays 5:00 AM to 2:00 PM The adults that reside in the home are the Licensee, her spouse Florencio, her daughters Berenice and Stephanie, and her son in law Juan Manuel. LPA observed there were four children present included two infants and two preschool age. Certification for CPR and First Aid Card for Licensee are current and will expire on 8/26/24 for licensee and on 4/09/23 for helper Berenice.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the children's roster today and it is current. LPA reviewed seven children's files and observed that parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification and emergency information forms are in each file. LPA observed that Licensee has conducted a fire drill during the last six months. Last fire drill was documented on 9/08/22.
The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: Three bedrooms, one bathroom, and the attached garage. Off limits areas outside: The far back yard where licensee has gens and chickens. The home has back yard and it is fenced, Licensee uses part of the back yard as a covered playground.
LPA observed a fully charged 3A40BC fire extinguisher last time serviced on 8/26/22, and at least one working smoke detector.
LPA observed the home has a carbon monoxide detector. LPA observed there are not stairs in the home. LPA observed the home does not have wall heaters, or bodies of water. The Licensee states that she does not have any weapons in the home. LPA reminded licensee that all the detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. According with the SB792, Licensee has in file proof of immunization for pertussis, measles, and influenza for herself and for her helper Berenice.

*******************Report dated 09/14/22 continues in page 2.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2022
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: CABALLERO, JOSEFINA
FACILITY NUMBER: 274413447
VISIT DATE: 09/14/2022
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Report dated 9/14/22 continues from page 1.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours 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 8 children in the home at any time and ratio (age of the children) must be observed. Licensee states that she does not transport children via vehicle and that she understands that children cannot be left in parked vehicles unattended at any time. Licensee uses redirection and communication with children as a form of discipline.
Department website: www.ccld.ca.gov provided to Licensee.

Licensee and her helper have completed the "Mandated Reporter" training on 5/20/21 and 6/3/21 respectively and Licensee was advised that all adults in contact with children are required to complete the "mandated reporter" training. LPA referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training.

A review of staff records on 9/13/22 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Licensee Josefina Caballero was reminded that all adults 18 and over living or working in the home, 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.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.

Report dated 9/14/22 continues on page 3.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
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: CABALLERO, JOSEFINA
FACILITY NUMBER: 274413447
VISIT DATE: 09/14/2022
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Report dated 9/14/22 continues from page 2.

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with the licensee Josefina Caballero

No deficiencies were cited.

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

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
LIC809 (FAS) - (06/04)
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