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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274418179
Report Date: 02/13/2025
Date Signed: 02/13/2025 12:54:33 PM

Document Has Been Signed on 02/13/2025 12:54 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:ZEPEDA FAUSTO, YANETFACILITY NUMBER:
274418179
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/13/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Yanet Zepeda FaustoTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Martha Jimenez-Villanueva conducted an announced pre-licensing inspection on February 13, 2025. LPA met with Yanet Zepeda Fausto, applicant, and explained the nature of today's inspection. Present at home was the applicant, her husband, and her child. Applicant stated that herself and her husband are the adults living at home. Children living at home are one son (7-year-old) and one daughter (5-year-old). The home is a one-story home with four bedrooms and two baths.

Days and hours of operation will be Monday – Saturday from 5:00 AM to 7:00 PM. Applicant completed her Preventative Health and Safety Training on June 21, 2024, and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on June 4, 2026. Applicant completed the Mandated Reporter Training on June 10, 2024, and a copy of the certification is on file. A copy of current TB test, MMR, Tdap, and flu vaccinations for the Applicant are on file.

The applicant provided proof of control of property. Lease agreement is 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 does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) to all enrolling families until she obtains liability insurance in the future.

LPA toured the indoor and outdoor areas of the home with the applicant. LPA observed the home has a central heather system and windows for safety and comfort of the children. LPA observed a covered screened fireplace located in the living room. OFF LIMITS areas inside/outside the home include: one master bedroom with bathroom, three bedrooms, closet, pantry room, attached garage, front driveway (left), front lawn area (right), and right-side yard and two locked storages. LPA observed the laundry area, and the water heater are in the garage. LPA observed door knobs cover protector on the 4 bedrooms doors and the garage door. LPA observed right-side yard is gated and backyard is fenced. ON LIMITS areas inside/outside the home include kitchen, dining and living room, one bathroom, backyard, and left-side yard (gated). LPA observed a porch in the left-side yard. Applicant stated will use the backyard and left side yard as play area and outdoor activities. Applicant understands that prior to making any change related to the on or off limits must be reported to Licensing.
Report Continues in LIC809-C page 2.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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 3
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: ZEPEDA FAUSTO, YANET
FACILITY NUMBER: 274418179
VISIT DATE: 02/13/2025
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Report LIC809-C page 2.

LPA observed the home is clean and orderly. Applicant has a working cellphone. LPA observed fully charged fire extinguisher 3A40BC, working at least one combo smoke and carbon monoxide detector. LPA observed there are not bodies of water, not stairs, and not weapons in the home. LPA observed a dog in the garage and applicant stated is vaccinated. There are toys, supplies, and equipment for the day care children indoors and outdoors. Cleaning products, toxic agents, medications, and sharp objects are inaccessible to children these products are in a top cabinet on the kitchen, under the sink and top shelf in the laundry area.

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 of the living room if necessary due to illness or communicable disease. Applicant has a First Aid kit and a digital thermometer.

Forms of discipline applicant will use: Talking with children, and redirection. Applicant understands that children's personal rights should not be violated, including no corporal punishment. Supervision of children, capacity options for a small license, 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 applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

LPA discussed the requirements of AB 633 with the applicant. LPA also discussed "Zero tolerance" related regulations with the applicant.

A review of staff records on 02/12/2025 indicated 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.

Report Continues in LIC809-C page 3.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
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: ZEPEDA FAUSTO, YANET
FACILITY NUMBER: 274418179
VISIT DATE: 02/13/2025
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Report LIC809-C page 3.
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

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. Entrance Checklist LIC 9280 was provided to the applicant.

LPA discussed the safe sleep regulations with applicant and, discussed the Child Care Licensing Safe Sleep web page 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.

On this date, 02/12/2025 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.

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 Yanet Zepeda Fausto in Spanish.

The applicant Yanet Zepeda Fausto was informed that a small Family Child Care Home license will be approved pending on the following:

Approval from a manager of the Licensing Program.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC809 (FAS) - (06/04)
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