274416060-5-20-2024-07-CC-MJVA-D5FQ7G-20240520115508

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274416060
Report Date: 05/20/2024
Date Signed: 05/20/2024 11:55:21 AM

Document Has Been Signed on 05/20/2024 11:55 AM - 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:	LOPEZ, JAQUELINE		FACILITY NUMBER:	274416060
ADMINISTRATOR/ DIRECTOR:	JAQUELINE LOPEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 776-2492
CITY:	KING CITY	STATE: CA	ZIP CODE:	93930
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 8	DATE:	05/20/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Jaqueline Lopez		TIME VISIT/ INSPECTION COMPLETED:	12:05 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 Analysts (LPA) Martha Jimenez-Villanueva met with licensee Jaqueline Lopez on May 20, at 9:45 am for an unannounced annual inspection. LPA explained the nature of today’s inspection. Licensee and assistant Monica had eight children in care: two infants, three toddlers and three preschoolers. Present (adults) were licensee and her assistant. Days and hours of operation are Monday to Friday from 6:000am to 5:00pm. Adults living in the home are the licensee, licensee's husband and licensee’s three children six, four and two years old. Licensee husband arrived at home later during today visit. A review of staff records on 5/15/2024 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 Jaqueline Lopez was reminded that all adults 18 and over living or working in the home, 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 per person will be assessed if this regulation is violated. LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed the home is one story home and LPA observed no stairs at home. No fireplace, no wall heater and no bodies of water. Licensee states there no weapons at home. LPA observed four dogs, licensee states ALL are vaccinated and two of them stay in the garage, one in a fenced backyard to the right and the small inside the house. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items inside the home are stored inaccessible to children and stored on the top of a cabinet in the kitchen. LPA observed a combo carbon monoxide/smoke detector operable. LPA observed a full 2A10BC fire extinguisher was serviced on 12/28/2023. The home is fenced inside, and the home has fenced backyard. Off limit areas: Master bedroom with bathroom, bedroom number 1 and 2, the laundry room, the attached garage, left side of yard and the right side of house. Shade is provided for the children by hardtop gazebo and outside the children have plastic play structures to play with. Continues in page 2…

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024

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: LOPEZ, JAQUELINE	FACILITY NUMBER: 274416060
	VISIT DATE: 05/20/2024

NARRATIVE

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LPA observed a fish tank located in the living room that is at least five (5) feet high and the body of water is inaccessible to children. LPA observed a cover on the top of the fish tank; however, the tank is high enough off the ground that children cannot access or reach the top of the tank.

LPA observed licensee and licensee's assistant have current CPR and First Aid certification expiring 01/2026 and 09/2025 and completed Mandated Reporter training dated 11/28/2023 and 04/20/2023 respectively.

LPA took a picture of a current roster of the children and a fire and disaster drill log which was last completed on 05/07/2024. LPA reviewed six children's files and observed all forms are completed and children have current immunization records. LPA observed LIC 9227 and current safe sleep log for infants in care. LPA observed LIC282 in children's files. Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is on file for licensee and licensee's assistant.

Supervision of children was discussed with 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. Licensee understands her capacity options and she understand that she cannot have more than 14 children in the home at any time. Applicant understands that children (her own) residing in the home count as part of the capacity of her license until they reach the age of ten years old. Licensee stated she does not transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.

LPA discussed the safe sleep regulations with licensee Jaqueline Lopez 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 Jaqueline Lopez 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.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024

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: LOPEZ, JAQUELINE	FACILITY NUMBER: 274416060
	VISIT DATE: 05/20/2024

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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/.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process

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

Exit interview conducted and report was reviewed with the licensee Jaqueline Lopez in Spanish.

During the exit interview, the LICENSEE Jaqueline Lopez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiency was cited.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024

LIC809 (FAS) - (06/04)

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