<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430758279
Report Date: 08/14/2024
Date Signed: 08/15/2024 09:15:11 AM

Document Has Been Signed on 08/15/2024 09:15 AM - 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GUTIERREZ, IVONNEFACILITY NUMBER:
430758279
ADMINISTRATOR/
DIRECTOR:		IVONE GUTIERREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
4084393700
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 6DATE:
08/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:46 PM
MET WITH:Ivonne GutierrezTIME VISIT/
INSPECTION COMPLETED:
04:10 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 08/14/2024 at 12:26pm, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced annual/random inspection. Licensee was not in the home and informed LPA that she was on her way home. Upon Licensee's arrival LPA was granted access to the home. LPA observed licensee's mother/assistant with 6 children including 2 infants, 3 preschool and one school age child. Licensee is operating with the ratio and capacity requirements of the license. Days and hours of operation are Monday to Friday, 5:00 am to 6:00 pm. LPA observed all required posted materials in the indoor play room of the home. This facility has one waiver that allows the wood burning stove in the on limit living room not to be screened. Licensee was in compliance with the conditions of the waiver. The adults that reside in the home are Licensee, licensee’s adult son and daughter. Licensee has no minor children residing in the home. Licensee provided LPA with an updated Application for Family Child Care Home License (LIC 279) during today's inspection.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408-439-3700). LPA observed sufficient materials, toys, and play equipment for the day care children. Furniture, such as tables, chairs, feeding chairs and shelves, are in good condition. The home has central heating/cooling and ventilation for comfort of children. On limit areas inside the home: living room, indoor playroom, hallway bathroom, dining room and kitchen. There are no stairs inside the home. Off limit areas outside the home: right and left side section. Backyard is fenced, both sides of the home are gated and no bodies of water were observed. The outdoor space and play equipment were observed to be maintained in safe condition and free of hazards. LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. The shower area is free on any hazards.

LPA observed a fully charged 3A40BC fire extinguisher in the indoor playroom and working smoke/carbon monoxide detectors. Licensee states that she does not have any weapons. Licensee states that she has a pet gecko in the home that does not interact with children.

Continued on Page 2
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GUTIERREZ, IVONNE
FACILITY NUMBER: 430758279
VISIT DATE: 08/14/2024
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
26
27
28
29
30
31
32
All detergents, cleaning compounds, poisons, medications, sharp objects and other similar items were observed to be stored inaccessible to children. LPA observed knives on the kitchen counter and LPA advised Licensee that since she cares for school age children the knives need to be placed in a higher location to be inaccessible to children in care. Licensee moved the knives during today's inspection. Licensee understands that smoking is prohibited in the home.

Filtered water for drinking is readily available for children in the home via water pitcher and disposable cups. Licensee states that she provides breakfast, lunch, snacks and dinner (occasionally) to the children in care. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was last conducted on 06/26/2024. LPA obtained copy of children's roster.

Children file review was completed and found to be current and up to date. Six (6) files were reviewed during today's inspection. Licensee does not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). LPA reviewed two infant child's file and the file was complete with the required forms, including the Individual Infant Sleeping Plan (LIC 9227). LPA reviewed 15-minute sleep logs for infants in care.

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-and-resources/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.

A review of staff 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 reviewed two staff files (Licensee and Mother/Assistant) and the files were complete with the required forms.

Continued on Page 3
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC809 (FAS) - (06/04)
Page: 2 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GUTIERREZ, IVONNE
FACILITY NUMBER: 430758279
VISIT DATE: 08/14/2024
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
26
27
28
29
30
31
32
Licensee and assistant have current Pediatric CPR/First Aid certification with an expiration date of 02/01/2025. Licensee and Assistant's Mandated Reporter Training expires on 01/23/2026. Licensee and staff have the required immunization in file for measles, pertussis and statement declining influenza.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

Supervision of children was discussed with Licensee, and she 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. LPA discussed the requirement for Licensee to be present at the facility 80 percent of the hours the facility is in operation and that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a qualified assistant must be present. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed.

LPA discussed "zero tolerance" related regulations which includes the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing updates and regulations.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she is not administering any medications or IMS services to children at this time. 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/.

Continued on Page 4
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GUTIERREZ, IVONNE
FACILITY NUMBER: 430758279
VISIT DATE: 08/14/2024
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
26
27
28
29
30
31
32
Licensee states that she does not transport any day care children. LPA reminded Licensee that if she decides to transport children, children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Licensee will submit an updated Emergency Disaster Plan (LIC 610A) and Facility Sketch (LIC 999A) to LPA by 07/28/2024.

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.

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

As a result of today's inspection, there were no deficiencies cited.

Exit interview conducted and report was reviewed with the Licensee, Ivonne Gutierrez

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS

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 the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4