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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417743
Report Date: 02/01/2024
Date Signed: 02/01/2024 03:48:21 PM

Document Has Been Signed on 02/01/2024 03:48 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:CORTES SIERRA, ANTONIAFACILITY NUMBER:
274417743
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 4DATE:
02/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Antonia Cortes SierraTIME COMPLETED:
03:55 PM
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Licensing Program Analysts (LPAs) Fermin Campos-Jaramillo and Martha Jimenez-Villanueva conducted an unannounced Case Management inspection to the home today. LPA explained licensee Antonia Cortes Sierra, the visit is to inspect her Family Child Care Home for the increase of capacity. Licensee has submitted an application for increase of capacity on 11/03/2023 and her home has been granted a clearance by the City of Salinas Fire Department on 1/25/2024. Licensee Antonia, her spouse Gilberto and her son Juan Pablo are the only adults residing in the two story home. LPAs observed two infants and two preschool age children were in care during the inspection. Days and hours of operation are Monday to Friday from 6:00 AM to 5:00 PM and Saturdays from 6:00 AM to 1:00 PM. Licensee's pediatric CPR and First Aid certifications are current and will expire on 1/07/25.
LPA toured the indoor and outdoor areas of the home during today's inspection. LPA observed there are not wall heaters in the home. LPA observed there are not bodies of water in the home. LPA observed there are barricaded stairs inside the home. Off limit areas inside the home: All the second floor, and the first floor: the laundry room, one closet, and the attached garage. Licensee understands that the garage is not approved for childcare in accordance with the Fire Clearance document. LPA observed licensee has a 3A40BC fire extinguisher in the home, and it was last time serviced on 10/30/23, the home has at least one working smoke detector, and at least one working carbon monoxide detector. Off limits outdoor areas are: The left side yard, licensee uses the back yard as playground for the children in care. LPA observed the back yard is fenced. Licensee states that there are no weapons in the home. Licensee understands that cleaning products, toxic agents, medications, and sharp objects shall not be accessible to children. Licensee has renewed the required "mandated reporter" training AB1207 on 11/06/2023..

Licensee was informed that if eventually a large license is granted, the maximum capacity is 14 and a qualified helper is required to be present whenever there are more than 8 children in care and ratio (age of the children) must be observed. Licensee understands that in absence of a qualified helper, her license capacity automatically returns to capacity 8 and ratio must be observed as well. Graphical material showing ratio for a large FCCH license was provided to the licensee.

*********Report dated 2/1/2024 continues on page 2
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
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: CORTES SIERRA, ANTONIA
FACILITY NUMBER: 274417743
VISIT DATE: 02/01/2024
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Report dated 2/01/2024 continues from page 1.

A review of staff records on 1/30/24 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 was reminded that all the 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.

No deficiencies were cited today.

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

Exit interview conducted and report was reviewed with licensee Antonia Cortes Sierra in Spanish.

Licensee Antonia Cortes Sierra was informed that a large Family Child Care Home license would be approved pending on the following: 1) Approval from a manager of the Licensing Program.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
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