274418209-2-28-2025-07-CC-MJVA-DEBSAU-20250228124256

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274418209
Report Date: 02/28/2025
Date Signed: 02/28/2025 12:43:12 PM

Document Has Been Signed on 02/28/2025 12:43 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:	PEREA CRUZ, GRACIELA		FACILITY NUMBER:	274418209
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	02/28/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Graciela Perea Cruz		TIME VISIT/ INSPECTION COMPLETED:	01:00 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 met with Graciela Perea Cruz, Applicant, to conduct an announced pre-licensing inspection. Applicant has applied for a small Family Child Care Home license. LPA was granted access to the apartment by the applicant. No other adult(s) or child(ren) were present in the apartment during today’s inspection. Per applicant, herself, her domestic partner, and her sister are the adults that resides in the home. There are three minors: daughter four-year-old, infant twenty-three months and nephew four-year-old residing in the home. The apartment is in a 2-story complex apartment. Apartment is downstairs with two bedrooms and one bath. Days and hours of operation will be Monday to Saturday from 5:00AM to 7:00PM. Applicant has completed her Preventative Health and Safety Child Care Training included the lead poisoning training on 09/19/2024. Applicant's pediatric CPR and First Aid certifications are current and will expire on 08/24/2026. Applicant completed Mandated Reporter training on 09/27/2024. Applicant's immunization in measles, pertussis, flu, and TB test are on file. The applicant provided proof of control of property (Rental/Lease Agreement 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 has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, she can operate with a maximum capacity of 6 children. Applicant stated that she will not have liability insurance for the day care and stated that she will issue the Affidavit Regarding Liability Insurance (LIC 282) form to all enrolled families. LPA toured the indoor and outdoor areas of the house with the applicant during today's inspection. There are no stairs inside the home. There is a screened covered wall heater inside the apartment. Applicant stated will be using all areas of the apartment including a fenced patio for outdoor activities of children. Kitchen and hallway area are gated. Off limit areas inside the home: two bedrooms (#1, 2) and three closets (#2, 3, 4). Report continues in LIC809-C page 2.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

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: PEREA CRUZ, GRACIELA	FACILITY NUMBER: 274418209
	VISIT DATE: 02/28/2025

NARRATIVE

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Report LIC809-C page 2.
The home is clean, orderly, including heating and ventilation, for safety & comfort. Applicant has a valid phone in the home (# 805-401-1853). There is sufficient toys, supplies, and equipment for the day care children indoors. Applicant understands that she must be present in the home at least 80% of the operating hours of the day care on a daily basis and ensure that the children are supervised at all times.

LPA observed a fully charged fire extinguisher (2A10BC), working combo smoke & carbon monoxide detectors, no bodies of water, and fenced backyard. Applicant stated that she does not have any weapons/ammunition and not pets in the home. Applicant stated that she will provide snack to the day care children. Applicant understands that any food or drink brought from home shall be labeled with each child's name and properly stored.

Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children and are in off limits areas: kitchen (below sink) and closet. Applicant stated that any poisons will be kept in the off limits always locked closet. 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 chair close to the entrance area if necessary due to illness or communicable disease. Applicant has a First Aid kit in the apartment. Applicant states that she does not transport children via vehicle and that she understands that children cannot be left in parked vehicles unattended at any time.

Forms of discipline to be used by Applicant: talking to children. Applicant understands that children's personal rights should not be violated, including no corporal punishment. Isolation of sick children, supervision of children, capacity options, 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 the applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

Applicant stated that she will not administer any medication to the 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) 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 PIN 22-02-CCP was provided to applicant.

Report Continues LIC809-C Page 3.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

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: PEREA CRUZ, GRACIELA	FACILITY NUMBER: 274418209
	VISIT DATE: 02/28/2025

NARRATIVE

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Report LIC809-C page 3.

Roster Report was reviewed on 02/05/2025 indicating 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.

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. Pre licensing Entrance Checklist – Family Child Care Homes (LIC 9280) was provided to the Applicant.

LPA discussed the safe sleep regulations with applicant, 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 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.

LPA discussed the requirements of Assembly Bill (AB) 633 with the applicant. LPA discussed "zero tolerance" related regulations with the applicant.

On this date, 01/22/2025 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.

Report Continues in LIC809-C page 4.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

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: PEREA CRUZ, GRACIELA	FACILITY NUMBER: 274418209
	VISIT DATE: 02/28/2025

NARRATIVE

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Report LIC809-C page 4.

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 Graciela Perea Cruz in Spanish, and advised her that a small Family Child Care Home license will be approved upon completion of the following:

Licensing Program Manager (LPM) review and approval.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

LIC809 (FAS) - (06/04)

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