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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274416899
Report Date: 11/07/2024
Date Signed: 11/08/2024 10:50:19 AM

Document Has Been Signed on 11/08/2024 10:50 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:FERNANDEZ, MARITSAFACILITY NUMBER:
274416899
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/07/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:33 PM
MET WITH:Maritsa FernandezTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA), Elizabeth Larios, met with Applicant, Maritsa Fernandez for announced pre-licensing inspection. The purpose of today's inspection is to ensure the home is in compliance with Title 22 California Code of Regulations. Upon arrival, LPA was admitted into the home by the Applicant and toured inside and outside during todays inspection.

The Applicant state that there are additional adults, over the age of 18, residing in the home. The Applicant spouse. LPA advised that children living in the home will be included in the home ratio and capacity until they turn 10 years of age. The hours of operation for the family child care home (FCCH) will be Monday - Friday, 6:00AM-6:00PM the Applicant is planning to offer care for children ages 3 months to 12 years old. The Applicant has submitted Property Owner/Landlord Consent LIC 9149 and does not currently have liability insurance for the day care. LPA advised the Applicant to provide parents with Affidavit Regarding Liability Insurance (LIC282) upon registration until liability insurance is purchased in the future.

The 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.

LPA toured inside the home and observed sufficient materials and play equipment for day care children. There are blocks, cars, puzzles, arts and craft materials, and other toys for children to play with. Off limits inside the home include: master bedroom/bathroom, two bedroom, bathroom, living room, and kitchen. There is a working telephone (cell phone) at the FCCH. The Applicant has one play yard ten cots with sheets for children to nap. The Applicant also has one highchair. LPA advised that mattress sheets should be changed between infants, if the crib is shared. LPA advised that infant sheets shall be washed daily.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: FERNANDEZ, MARITSA
FACILITY NUMBER: 274416899
VISIT DATE: 11/07/2024
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The Applicant states she will not offer Incidental Medical Services. Food, snacks, and drinks will be prepared by Applicant. The Applicant states she is interested to work with a food program, and subsidized payment programs. Water will be provided for children from water dispenser served in plastic cups. LPA observed cleaning compounds and kitchen knives properly stored inaccessible to children. The fridge for storing children's food is properly maintained.

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: http://www.ada.gov/childqanda.htm

The bathroom in the home is clean, sanitary, and operable. The Applicant has a diaper changing station & pad. Applicant plans to assist with potty training and will be purchasing potty training seat. There was a waste bin with a tight fitting lid in bathroom.

LPA toured outside the home and observed the backyard patio fenced. No outdoor bodies of water were observed during todays inspection. Children will have access to half of backyard and side yard on the left side of house.

LPA observed fully charged 3A40ABC fire extinguisher that is located on the left side house door entrance of day care, functioning smoke detectors and carbon monoxide detector. LPA advised completing annual maintenance for the fire extinguisher. The Applicant was provided fire/emergency disaster drill log and was advised drills should be completed every 6 months.

The Applicant state that for discipline of the children, she will talk verbally with the child and use redirection as needed. LPA advised that if utilized, the recommended duration for "time out" is 1 minute per year of age for the child. The Applicant understands that children's personal rights should not be violated; including no corporal punishment. Children should not be left for extended periods of time in furniture such as a high chair or play pen.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: FERNANDEZ, MARITSA
FACILITY NUMBER: 274416899
VISIT DATE: 11/07/2024
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LPA discussed isolation of sick children with the Applicant and state that if a child were to start feeling sick at her home that she would isolate the child in the entry area with a napping cot, until the parent/guardian arrives to pick-up. LPA discussed isolation strategies, such as using a baby gate, and utilizing the restroom if the child's symptoms need close restroom access. Applicant has a first-aid kit and thermometer available in her home.

LPA additionally discussed supervision of children, unusual incidents (LIC624B), and requirements for additional staff/ adults living in the home. The Applicant states she does not plan to transport children at this time. The Applicant understands she must be home at least 80% of the time FCCH is open.

LPA reviewed small family child care home capacity requirements with the Applicant and provided copy of 102416.5 Staffing Ratio and Capacity from California Code of Regulations. The Applicant understands the requirements of one child in kindergarten or elementary school and at least one child age six for capacity of eight (complete LIC9150). There should never be more than four infants present at the FCCH. LPA advised the Applicant that infants are children under 2 years of age.

LPA reviewed with the Applicant LIC 311D- Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. LPA discussed required postings with Applicant and provided copies of Parents Rights bulletin (PUB394) and Earthquake Preparedness Checklist (LIC9148). LPA discussed Provider Information Notices (PINs). LPA additionally reviewed CCLD website and online annual fee payment.

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.

LPA discussed the safe sleep regulations with the Applicant and provided 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.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: FERNANDEZ, MARITSA
FACILITY NUMBER: 274416899
VISIT DATE: 11/07/2024
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The Applicant were 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 Applicant, Maritsa Fernandez.

LPA advised the Applicant that a small FCCH license will be issued pending manager review.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4