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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434402266
Report Date: 12/29/2022
Date Signed: 12/29/2022 09:28:19 PM

Document Has Been Signed on 12/29/2022 09:28 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MANOSCA, WILHELMINAFACILITY NUMBER:
434402266
ADMINISTRATOR:MANOSCA, WILHELMINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
4082507175
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
12/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:44 AM
MET WITH: Wilhelmina Monosca TIME COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analyst (LPA), Stephanie Collins, conducted an unannounced annual inspection of the Preschool. LPA met with Licensee Wilhelmina Monosca and informed her the purpose of the visit.

LPA arrived at the facility at 10:44 A M. Notification of Parents’ Right Poster, Children's Personal Rights, Child Care License, LIC 610 Emergency Disaster Form (1and 2). Facility’s operating days and hours are Monday-Friday 06:30 AM to 11:30 PM.

During visit, LPA observed one (1) child in program. Adults residing in the home are the licensee and her husband (Roberto Manosca) All adults present are associated to the facility.

Licensee Wilhelmina was remind that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA inspected the home inside and out with Licensee Wilhelmina . Off limits area of the home are the whole second floor, the living room and garage on the first floor. There is a child safety gate installed at the entryway to the stairs to prevent children from accessing the living room and stairs leading up to the second floor. Backyard is fenced and is used for outdoor activity. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Restroom for children to use were observed to be in operating conditions. Sick children can use one downstairs bedroom for isolation when required. Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. LPA observed that food storage areas were clean, free of litter, rubbish, and rodents/vermin. Foods and beverages were kept protected against contamination and spoilage.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE: DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/29/2022
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MANOSCA, WILHELMINA
FACILITY NUMBER: 434402266
VISIT DATE: 12/29/2022
NARRATIVE
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There were no bodies of water observed. Licensee stated that home does not have weapons on the premises. Drinking water is arranged to be readily available to children. Shade is provided by trees, are off limits if the storage bin which lock. building overhang, etc. First Aid kit was inspected. Smoke and

Log recorded that the last fire/disaster drill was conducted on(9/17/22). LPA reviewed homes roaster.

At 11:10 AM children's and staff files was selected for review. Children records reviewed includes: Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Medical Assessment, and immunization. Staff records reviewed all files were observed to be complete. Licensee is current on her Pediatric CPR/1st Aid Training.

This facility provides Incidental Medical Services – currently the facility does not have any children in care who requires IMS. 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: http://www.ada.gov/childqanda.htm.

Safe Sleep

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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


SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MANOSCA, WILHELMINA
FACILITY NUMBER: 434402266
VISIT DATE: 12/29/2022
NARRATIVE
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LPA reviewed with LIcensee the violations that would result in an immediate $500 civil penalty assessment. Director is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: ccld.ca.gov] to access resources for Providers, Regulations etc. State licensing fees were observed to be current.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

In the areas that were evaluated, regulatory violations were observed at the time of the inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Wilhelmina.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 12/29/2022 09:28 PM - It Cannot Be Edited


Created By: Stephanie Collins On 12/29/2022 at 08:08 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: MANOSCA, WILHELMINA
FACILITY NUMBER: 434402266

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)

An emergency information card shall be be maintained for each child [...] parent's authorizations for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in [1] out of [1 of the children present today, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/30/2022
Plan of Correction
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The Licensee will obtain required documentation for C-1 in care today and submit to the Department by 12/30/2022. LPA advised that drop-in children should have the required documentation.
Type B
Section Cited
CCR
102418(g)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in [1] out of [1] in C-1 is missing their immunization records, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/30/2022
Plan of Correction
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Licensee will request child C-1 immunization's from parents and will submit a copy of the completed records. LPA advised that drop-in children should have the required documentation.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Stephanie Collins
LICENSING EVALUATOR SIGNATURE:
DATE: 12/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/29/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/29/2022 09:28 PM - It Cannot Be Edited


Created By: Stephanie Collins On 12/29/2022 at 08:44 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: MANOSCA, WILHELMINA
FACILITY NUMBER: 434402266

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)

(d) at the time of acceptance of each child into care, The licensee shall provide the child's parent or authorized representative with a copy of the noice Family Child Care Home Notification of Parent Rights, LIC995 (8/06), [...]

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in [1] out of [3], C-1 does not have LIC 995A in file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/30/2022
Plan of Correction
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Licensee will provide LIC 995A to Parent to complete and will submit a copy of the completed form to CCL office by or before POC date.
Type B
Section Cited
CCR
102416.5(h)
Staffing Ratio and Capacity: For a Large Family Child Care home that meets the criteria to care fo upto two additional children, the licensee shall main proof of parent notificaiton as specified in Section 1597.465(c) of the Health and safety code.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review), the licensee did not comply with the section cited above in [1] out of [1],C-1 does not have a the form LIC 9150 ( Parent Notification Of Additional Children in Care) in file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/30/2022
Plan of Correction
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Licensee will provide proof of LIC 9150 for C-1 and submit to CCL Office by or before POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Stephanie Collins
LICENSING EVALUATOR SIGNATURE:
DATE: 12/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/29/2022


LIC809 (FAS) - (06/04)
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