274417821-8-23-2024-07-CC-ACOZ-D8EVAF-20240823161553

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274417821
Report Date: 08/23/2024
Date Signed: 08/23/2024 04:15:59 PM

Document Has Been Signed on 08/23/2024 04:15 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:	ANDRESI, JESSICA		FACILITY NUMBER:	274417821
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS:	DATE:	08/23/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:20 PM
MET WITH:	Jessica Andresi		TIME VISIT/ INSPECTION COMPLETED:	04:25 PM

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August 23, 2024, at 2:20PM Licensing Program Analyst (LPA) Andrea Cortez conducted an announced Pre-licensing for a Small Family Childcare Home.

LPA met with Applicant, Jessica Andresi and explained the pre-licensing inspection. Applicant is the homeowner. Applicant will provide an affidavit to parents that she does not carry insurance. The hours of operation are Monday through Saturday 5:00AM to 5:00PM.

LPA toured the indoor and outdoor areas of the home during inspection:
Off Limits Areas: master bedroom 1, master bathroom, bedrooms 2,3,4,5 upstairs bathroom and garage.
On Limit Areas: kitchen, dining area, hallway bathroom, living room, and backyard

Fire drills are to be conducted are every 6 months. Applicant will maintain a current children's' roster. The Applicant has a working cell phone in the home. LPA observed toys and play equipment for the day care children. All detergents, cleaning compounds, other similar items and poisons are inaccessible to children.

LPA observed a fully charged fire extinguisher in the kitchen. There are working smoke & carbon monoxide detectors in the home. LPA did not observe any bodies of water. The Applicant understands that all pools, spas, hot tubs, fishponds, or similar bodies of water shall be covered or fenced as specified in Title 22 regulations to be inaccessible to children. Applicant states that there are no weapons or firearms in the home.

LPA informed Applicant that Licensing forms and Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

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: ANDRESI, JESSICA	FACILITY NUMBER: 274417821
	VISIT DATE: 08/23/2024

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LPA bookmarked PIN’s, Guardian, and Safe Sleep.

Incidental Medical Services (IMS) policy was discussed. Applicant currently does not offer. When any IMS is provided, an updated Plan of Operation that includes IMS and 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

A review of guardian records indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded applicant of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12- month period.

Supervision of children was discussed with the Applicant. Applicant understands that she must be present in the home at least 80 percent of the hours the day care is in operation and ensure that the children are always supervised. The Applicant understands her capacity ratios.

The Applicant states that she will transport children and understands that children cannot be left in parked vehicles unattended at any time. Applicant understands that children's personal rights should not be violated, including no corporal punishment. Isolation of sick child, requirements for reporting suspected child abuse, unusual incidents/injuries, heat-related illnesses, and requirements for assistant/substitute were also discussed.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

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: ANDRESI, JESSICA	FACILITY NUMBER: 274417821
	VISIT DATE: 08/23/2024

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Applicant understands that the application for a small childcare license is to be reviewed by Management prior to licensing approval.

Upon the issuance of Type A citations, a copy of the Facility Evaluation Report LIC809 must be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

An exit interview was conducted, was reviewed with the Applicant. A copy of this report was discussed and left with the Applicant, Jessica Andresi, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

LIC809 (FAS) - (06/04)

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