274417467-2-21-2025-07-CC-MJVA-DE4SCK-20250221124541

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274417467
Report Date: 02/21/2025
Date Signed: 02/21/2025 12:45:51 PM

Document Has Been Signed on 02/21/2025 12:45 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:	ROCHA, LETICIA		FACILITY NUMBER:	274417467
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	02/21/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Leticia Rocha		TIME VISIT/ INSPECTION 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) Martha Jimenez-Villanueva met with Leticia Rocha, Applicant, to conduct an announced pre-licensing inspection. Applicant has applied for a small Family Child Care Home license. The home is in a townhouse complex with a gate entrance. LPA was granted access with a gate code to the home by the applicant. No other adult(s) or child(ren) were present in the home during today’s inspection. Per applicant, herself is the only adult that resides in the home. There is one minor child (3 three-year-old residing in the home. The home is one story home with two (2) bedrooms and two (2) baths. Days and hours of operation will be Monday to Saturday from 4:00AM to 6:00PM. Applicant has completed her Preventative Health and Safety Child Care Training included the lead poisoning training on May 17, 2024. Applicant's pediatric CPR and First Aid certifications are current and will expire on October 9, 2026. Applicant completed Mandated Reporter training on August 17, 2024. Applicant's immunization in measles, pertussis, TB test and declined statement for flu are on file. The applicant rents/leases the apartment and provides proof of control of property (Lease Agreement) on file. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Applicant stated that she will not have liability insurance for the day care and stated that she will issue the Affidavit Regarding Liability Insurance (LIC 282) form to all enrolled families. LPA toured the indoor and outdoor areas of the home with the applicant during today's inspection. There are no stairs inside the home. LPA observed security doors and stove knob covers. There are a glass covered fireplace in the living room and a wall heater unit in the hallway inside the home. Off limit areas inside the home: master bedroom, master bathroom, front porch and attached garage. Applicant stated will use the entire backyard for outdoor activities and playground. Report continues in LIC809-C page 2.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

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: ROCHA, LETICIA	FACILITY NUMBER: 274417467
	VISIT DATE: 02/21/2025

NARRATIVE

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Report LIC809-C page 2.
The home is clean, orderly, including heating and ventilation, for safety & comfort. Applicant has a valid phone in the home (# 831-334-5421). There is sufficient toys, supplies, and equipment for the day care children indoors. Applicant understands that she must be present in the home at least 80% of the operating hours of the day care on a daily basis and ensure that the children are supervised at all times. Applicant understands her capacity options and she understand that she cannot have more than 8 children in the home at any time with at least one qualified adult.

LPA observed a fully charged fire extinguisher (3A40BC), working smoke & carbon monoxide detectors, no bodies of water, and fenced backyard. Applicant stated that she does not have any weapons/ammunition or pets in the home. Applicant stated that they will provide all meals, including snacks and lunch, to the day care children. Applicant understands that any food or drink brought from home shall be labeled with each child's name and properly stored.

Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children and are in two top cabinets in the kitchen, and the garage. Applicant stated that any poisons will be kept in the off limits attached garage. LPA reminded applicant that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. Applicant stated that a child will be isolated in a corner close to the entrance area if necessary due to illness or communicable disease. Applicant has a First Aid kit with a touchless thermometer in the home. Applicant stated that she does not transport children via vehicle and that she understands that children cannot be left in parked vehicles unattended at any time.

Forms of discipline to be used by Applicant: talking to children. Applicant understands that children's personal rights should not be violated, including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed the applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

Applicant stated that she will not administer any medication to the children at this time. 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) or (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

Report Continues LIC809-C Page 3.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

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

FACILITY NAME: ROCHA, LETICIA	FACILITY NUMBER: 274417467
	VISIT DATE: 02/21/2025

NARRATIVE

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Report LIC809-C page 3.

PIN 22-02-CCP - Best Practices Related to the Provision of Incidental Medical Services in Child Care Center and Family Care Homes was provided to Applicant.

Roster Report was reviewed on 01/16/2025 indicating that all the adults residing in the home or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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, 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 reviewed with applicant, the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Pre licensing Entrance Checklist – Family Child Care Homes (LIC 9280) was provided to the Applicant.

LPA discussed the safe sleep regulations with applicant, 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 applicant, 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.

LPA discussed the requirements of Assembly Bill (AB) 633 with the applicant. LPA discussed "zero tolerance" related regulations with the applicant.

On this date, 12/05/2024 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Report continues LIC809-C page 4.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: ROCHA, LETICIA	FACILITY NUMBER: 274417467
	VISIT DATE: 02/21/2025

NARRATIVE

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Repot LIC809-C page 4.

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

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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Leticia Rocha in Spanish, and advised her that a small Family Child Care Home license will be approved upon completion of the following:

Licensing Program Manager (LPM) review and approval.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

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