434402447-6-28-2024-07-CC-FRAA-D6NML6-20240628094145

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434402447
Report Date: 06/27/2024
Date Signed: 06/28/2024 09:42:01 AM

Document Has Been Signed on 06/28/2024 09:42 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:	LAM, REBECCA		FACILITY NUMBER:	434402447
ADMINISTRATOR/ DIRECTOR:	LAM, REBECCA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 238-1230
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95121
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 7	CENSUS: 7	DATE:	06/27/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:28 PM
MET WITH:	Rebecca Lam		TIME VISIT/ INSPECTION COMPLETED:	04:20 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	On 06/27/2024 at 12:28 pm, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced annual/random inspection. LPA was granted access to the home by Licensee, Rebecca Lam, and explained the nature of today’s inspection. Present during the inspection were licensee, spouse and 7 children including one infant and 6 preschool age. Licensee was operating within the ratio and capacity requirements of her license. Days and hours of operation are Monday to Friday, 8 am to 5:30 pm. LPA observed all required posted materials in the play area of the home. The adults that reside in the home are licensee and spouse. Licensee has no minor children residing in the home. All individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408-694-2165). LPA observed sufficient materials, toys, and play equipment for the day care children. Furniture, such as tables, chairs, cribs, feeding chairs and shelves, are in good condition. The home has central heating/cooling and ventilation for comfort of children. The home is single story. As per licensee's spouse, the on limit areas include living room, family room including extension, bathroom (in the extension), master bedroom, master bathroom, two bedrooms, office and one bathroom. Off limit areas inside the home as per licensee's spouse is the attached garage. LPA observed a barricaded fireplace in the family room. Off limit areas outside the home: gated left and right side section and are barricaded with a chain link fence. Backyard is fenced. Outdoor toys and play equipment was observed to be age appropriate. LPA observed artificial grass under play area to absorb falls. There are no bodies of water observed. LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. The shower area is free of any hazards. All detergents, cleaning compounds, medications, sharp objects and other similar items are stored inaccessible to children. Licensee will submit an updated facility sketch to LPA by 07/11/2024. LPA observed a fully charged 3A40BC fire extinguisher in the play area and working spoke and carbon monoxide detectors. Licensee states that there are no weapons or pets in the home. Licensee understands that smoking is prohibited in the home. Continued on Page 2

Gladys Kuizon
Farida Raja
	DATE: 06/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024

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: LAM, REBECCA	FACILITY NUMBER: 434402447
	VISIT DATE: 06/27/2024

NARRATIVE

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LPA observed a baby bouncer in the on limit family room. Licensee stated that they inserted bolts on the sides to prevent the rocker from rocking so they can continue using it. LPA informed Licensee that since it is not being used as per manufacture instructions and changes made to the bouncer may not necessarily be safe for children to use or play with.

Drinking water is readily available for children in the home via individual water bottles. Licensee states that she provides breakfast, lunch and snacks to the children in care. Licensee is part of a food program. 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 04/11/2024. LPA obtained copy of children's roster. Children file review was completed and found to be current and up to date. Seven (7) children’s files were reviewed during today's inspection. Licensee carries daycare insurance. Licensee has liability insurance through Markel Insurance and LPA verified valid coverage. LPA discussed the safe sleep regulations with Licensee. LPA discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA reminded licensee that if an infant is sleeping in a separate room from where the provider is stationed the door to the room the infant is sleeping in shall remain open at all times. The provider shall be able to visually observe the infant without moving the door.

Staff file review was completed and found to be current and up to date. LPA reviewed two staff files (licensee and spouse/assistant) and the files were complete with the required forms. Licensee and spouse have current Pediatric CRP/First Aid training that expires on 05/28/2025. Licensee has proof of immunization in file for measles and pertussis. Licensee stated that she has taken the influenza immunization but is unable to provide proof of vaccine. LPA reminded Licensee to maintain proof of influenza immunization's. Licensee's Mandated Reporter Training expires on 02/17/2025. Licensee understands the training is mandatory to all licensees and adults in the home in contact will children and requires renewal every two years.

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SUPERVISOR'S NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024

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: LAM, REBECCA	FACILITY NUMBER: 434402447
	VISIT DATE: 06/27/2024

NARRATIVE

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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. 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.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she is not providing any medication or IMS to children in care 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/.

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SUPERVISOR'S NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024

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: LAM, REBECCA	FACILITY NUMBER: 434402447
	VISIT DATE: 06/27/2024

NARRATIVE

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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.

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.

One Type B deficiency was cited today as a result of today's inspection. Appeal Rights were provided. Exit interview conducted and report was reviewed with the licensee, Rebecca Lam.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 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.

SUPERVISOR'S NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/28/2024 09:42 AM - It Cannot Be Edited

Created By: Farida Raja On 06/27/2024 at 03:42 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: LAM, REBECCA	FACILITY NUMBER: 434402447
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(10)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. LPA observed a baby bouncer in the on limit family room. Licensee stated that they inserted bolts on the sides to prevent the rocker from rocking so they can continue using it. LPA informed Licensee that since it is not being used as per manufacture instructions and changes made to the bouncer may not necessarily be safe for children to use or play with.
	POC Due Date: 06/28/2024
	Plan of Correction
1 2 3 4	Licensee will submit a plan of correction to LPA by 06/28/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Farida Raja

LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024

LIC809 (FAS) - (06/04)

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