274418208-3-7-2025-07-CC-MJVA-DEJTX2-20250307140626

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274418208
Report Date: 03/07/2025
Date Signed: 03/07/2025 02:06:39 PM

Document Has Been Signed on 03/07/2025 02:06 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:	GUERRERO GUILLEN, MARIA		FACILITY NUMBER:	274418208
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/07/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Maria Guerrero Guillen		TIME VISIT/ INSPECTION COMPLETED:	02:20 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 conducted an announced pre-licensing inspection on March 7, 2025. LPA met with Maria Guerrero Guillen, Applicant, and explained the nature of today's inspection. Present at home was the applicant. Applicant stated that herself and her son and daughter are the adults living at home. Children living at home are one daughter (14-year-old). The Applicant's home is single story home located in a mobile home park with three bedrooms and two baths. Days and hours of operation will be Monday – Sunday from 12:00 AM to 11:30 PM. Applicant completed her Preventative Health and Safety Training on 10/31/2024, and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 10/05/2026. Applicant completed the Mandated Reporter Training on 11/14/2024, and a copy of the certification is on file. A copy of current TB test, MMR, Tdap vaccinations and a declined statement for flu for the applicant are on file. The applicant provided proof of control of property. As a proof copy of Deed document is on file. 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 mobile home with the Applicant. There are not stairs, not wall heater, not weapons and not bodies of water in the home. LPA observed fully charged fire extinguisher 3A40BC, working at least one combo smoke and carbon monoxide detector. LPA observed the home has an electric fireplace glass covered and a ceiling fan for safety and comfort of the children. OFF LIMITS areas inside/outside the home include: one master bedroom with master bathroom and closet, two bedrooms, two closet, kitchen, and laundry area, outside: front porch, right side carport area, locked storage, and backyard. LPA observed gated kitchen inside the home and children area outside and backyard area. Applicant noted on her Facility sketch that the kitchen is "in limits", however, applicant has elected not to make the kitchen in limits. LPA observed backyard is fenced. Applicant stated will use the right side yard as play area and outdoor activities. Applicant understands that prior to making any change related to the in or off limits must be reported to Licensing. Report Continues LIC809-C page 2.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

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 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: GUERRERO GUILLEN, MARIA	FACILITY NUMBER: 274418208
	VISIT DATE: 03/07/2025

NARRATIVE

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Report LIC809-C page 2.

LPA observed the home is clean and orderly. Applicant has a working cellphone (831-756-5621). LPA observed a dog in a bedroom 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 in the kitchen, under the sink and 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 the sofa in the dining room if necessary due to illness or communicable disease. Applicant has a First Aid kit.

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 02/17/2025 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 LIC809-C page 3.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

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: GUERRERO GUILLEN, MARIA	FACILITY NUMBER: 274418208
	VISIT DATE: 03/07/2025

NARRATIVE

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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, 01/15/2025 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.

Report Continues LIC809-C page 4.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

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: GUERRERO GUILLEN, MARIA	FACILITY NUMBER: 274418208
	VISIT DATE: 03/07/2025

NARRATIVE

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Report LIC809-C page 4.

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 Maria Guerrero Guillen in Spanish.

The applicant Maria Guerrero Guillen was informed that a small Family Child Care Home license will be approved pending on the following:

Applicant will gate hallway inside the home. Submit photo.

Applicant will secure locks in the sink/cabinets in the bathroom area. Submit photo.
Applicant will update LIC 999A to reflect changes. Submit form.
Approval from a manager of the Licensing Program.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

LIC809 (FAS) - (06/04)

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