274418188-3-25-2026-07-CC-MJVA-DSHU3Q-20260325151356

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274418188
Report Date: 03/25/2026
Date Signed: 03/25/2026 03:14:14 PM

Document Has Been Signed on 03/25/2026 03:14 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:	CHAVEZ, MARIA		FACILITY NUMBER:	274418188
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 6	CENSUS: 4	DATE:	03/25/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Maria Chavez		TIME VISIT/ INSPECTION COMPLETED:	03:30 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	On 03/25/2026, Licensing Program Analyst (LPA) Martha Jimenez-Villanueva met with licensee Maria Chavez for an unannounced annual and increase of capacity Inspection from 8 to 14 children. LPA explained the reason for the visit. Present was licensee with four children in care: one infant, two preschool age and one school age. Later for the inspection was present her granddaughter. The adults that reside in the home are herself, her granddaughter (S1) and her ex-daughter in-law (S2). Per licensee, no children in the home. All required posting materials were posted. Days and hours of operation are Monday to Sunday from 3:00AM to 2:00AM. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Licensee does not carry insurance for child care at this moment, If a Large FCCH is approved she will obtain one. The home received a Fire Inspection Clearance granted on March 17, 2026, by Salinas Fire Department. Fire pull station is near childcare room by the hallway. The following areas are approved for childcare according to the Fire Inspection document: second living and dining room, one bathroom, left side yard and backyard. No special conditions. Licensee understands the on limits and off-limits areas have been approved by the Fire District Authority and before making any changes to the use of the areas Licensee will notify the Licensing Program. LPA toured the indoor and outdoor areas during today's visit. LPA observed blocked fireplace, gated stairs and no wall heater inside the home. Off-limit areas: the entire second floor, first living and dining area, one bedroom, laundry area, kitchen, attached garage and pantry area on the first floor, the front yard, the right driveway, right side yard and a locked storage in the backyard. LPA observed a playground equipment set and a trampoline in the left side yard. LPA required licensee to follow Manufacturer label and compliance with use regulations. LPA observed three pets with current vaccination reports, licensee and stayed in the garage. LPA observed a glass covered fish tank in the second dining room. LPA observed children area is gated. Backyard is fenced. Report continues in next pages.

NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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Document Has Been Signed on 03/25/2026 03:14 PM - It Cannot Be Edited

Created By: Martha Jimenez-Villanueva On 03/25/2026 at 12:47 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CHAVEZ, MARIA	FACILITY NUMBER: 274418188
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/25/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421(b)

Child's Records

(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and records review, the licensee did not comply with the section cited above in Children file's (C1 to C4) did not have forms and/or documentation required, including LIC 9227 and sleep log for infants in care which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/08/2026
	Plan of Correction
1 2 3 4	Licensee will submit proof of children's files with complete forms and documentation required including LIC 9227 and sleep logs for children in care by the end of business day of 04/08/2026 to San Jose Regional Office.

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records review, the licensee did not comply with the section cited above in licensee did not have a current roster for children in care which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/08/2026
	Plan of Correction
1 2 3 4	Licensee will submit proof of current roster for children in care by the end of business day of 04/08/2026 to San Jose Regional Office.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Mireya Flores
NAME OF LICENSING PROGRAM MANAGER:

	Martha Jimenez-Villanueva
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

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: CHAVEZ, MARIA	FACILITY NUMBER: 274418188
	VISIT DATE: 03/25/2026

NARRATIVE

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LPA observed a fully charged fire extinguisher 2A10BC that was serviced on 03/17/2026, functioning combo smoke detector and carbon monoxide (CO) detector and a fire/disaster drill log was conducted on 03/25/2026. LPA did not observe bodies of water. Applicant stated there are no weapons/ammunition at home.

The home is clean, orderly, including ventilation for safety and comfort for children in care. Cleaning products, medications, sharp objects, and other items that are dangerous to children were stored inaccessible under locked bathroom sink, top rack laundry area and top corner kitchen. LPA observed sufficient age-appropriate materials, toys, and play equipment indoors and outdoors areas. The children's bathroom is clean, sanitary, and operable. The home has a working telephone. Licensee stated that a child will be isolated in the sofa in the first living room close to entrance, if necessary, due to illness or communicable disease. Licensee stated that she transports day care children. Licensee understands that children shall not be left unattended in parked vehicles must use appropriate car seats according to the child's age/weight/size and car seat cannot be used for sleeping. LPA reviewed DL, car insurance and registration are current.

Licensee understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands that she must be present in the home during day care hours (80% of the operating hours). Licensee understands her current capacity options and she understands if eventually she obtains a large license with capacity 14, she cannot have more than 14 children in the home at any time and a qualified assistant must be present and ratio (age of the children) must be observed. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio must be observed as well. LPA reviewed and provided the capacity worksheet to licensee and (S1).

Licensee did not have a current roster for children in care. LPA reviewed four (4) children’s files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Affidavit Regarding Liability Insurance for FCCH (LIC 282), Infant Sleep Plan (LIC9227), sleep log for children under 2 years old, and Immunization Records. Children file's (C1 to C4) did not have forms and/or documentation required including LIC 9227 and no sleep log for infants in care. LPA discussed SB792 Immunization requirements and observed licensee has immunization records, including TB and flu. LPA observed licensee has current Pediatric CPR/First Aid certifications expiring 09/17/2026 and completed Mandated Reporter Training completed on 09/26/2026. LPA reminded Mandated Reporter Training needs to be renewed every two years.

Report continues in next pages.

NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

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: CHAVEZ, MARIA	FACILITY NUMBER: 274418188
	VISIT DATE: 03/25/2026

NARRATIVE

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Roster Report was reviewed on 03/11/2026 indicating 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 adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption prior to initial presence in a 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 the regulation is violated.

Licensee stated that she does not administer any medications to the day care 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding www.cdss.cs.gov/inforesources/community-care-licensing/inspection-process.

LPA discussed the safe sleep regulations with Licensee 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 licensee 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.

Licensee was 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.

Report continues in next pages.

NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

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: CHAVEZ, MARIA	FACILITY NUMBER: 274418188
	VISIT DATE: 03/25/2026

NARRATIVE

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During the exit interview, the LICENSEE Maria Chavez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee Maria Chavez in Spanish. Appeal rights was handed to the licensee. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

The following type B deficiencies were cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

Licensee Maria Chavez was informed that a Large Family Child Care Home license would be approved pending on the following:
1) Completion of POC dated 03/25/2026, due date April 8, 2026.
2) Approval from a manager of the Licensing Program.

NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

LIC809 (FAS) - (06/04)

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