434402733-2-17-2023-07-CC-FRAA-CP5PYY-20230217104443

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434402733
Report Date: 02/13/2023
Date Signed: 02/17/2023 10:45:15 AM

Document Has Been Signed on 02/17/2023 10:45 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:	CAPISTRANO, LEONIE		FACILITY NUMBER:	434402733
ADMINISTRATOR:	LEONIE CAPISTRANO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 274-3046
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	02/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Leonie Capistrano		TIME COMPLETED:	11:45 AM

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 Analysts (LPA's), Farida Raja and Anna Morales, conducted an unannounced 1- year annual inspection. LPA's were granted access to the home by Licensee-Leoni Capistrano and explained the nature of today’s inspection. LPA observed 1 adult and 5 preschool age children in the home during today’s inspection. Days and hours of operation are Monday to Friday 7:30 am to 5:30 pm. LPA observed all required posted materials, including facility license and Notification of Parents' Rights, near the front entrance to the home. The adults that reside in the home are License and her husband . Licensee has 4 minor children, ages 8, 10, 14 and 16 residing in the home. LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408) 274-3046. The home is clean and orderly. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. The floors were clean and free of tripping hazards. The home has central heating/cooling and ventilation, and is comfortable for children. The home is two story and LPA observed barricaded stairs during today's inspection. Off limit areas inside the home: entire upstairs , downstairs(one living room , kitchen), attached garage, barricaded fireplace. The sun room is off limits for now. Off limit areas outside the home: left side section the backyard. Backyard is fenced. LPA's observed play structures in the backyard that are safe and secure for the children. There are no bodies of water. There are no wall heater units inside the home. LPA observed a fully charged 3A40BC fire extinguisher and working smoke/carbon monoxide detectors. The Licensee states that she has weapons which are stored in the master bedroom which is off limits to children. the ammunition is stored in a separate safe in an off limit area. The licensee had one dog in the home. All detergents, cleaning compounds, medications, sharp objects and other similar items are stored inaccessible to children. Licensee has a first aid kit in the home. Licensee understands that smoking is prohibited in the home.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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: CAPISTRANO, LEONIE	FACILITY NUMBER: 434402733
	VISIT DATE: 02/13/2023

NARRATIVE

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Drinking water is readily available for children in the home. Licensee provides breakfast, lunch and snack to daycare children. .Licensee understands that any food brought from home shall be labeled with each child's name and properly stored.

LPA's reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was conducted on 12/01/2022. Four (4) children’s files were reviewed during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), and Immunization Records (PM 286/CDPH 286). Licensee's liability insurance is expired. Licensee will renew and send a copy to LPA.

Licensee file was reviewed. Licensee has current CPR and First Aid certifications (expiration: 07/2024). Licensee has the required vaccines (MMR, Tdap, & flu - opt out). Licensee's Mandated Reporter Training has expired on 1/29/2022. LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with applicant Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

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. The 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.

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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: CAPISTRANO, LEONIE	FACILITY NUMBER: 434402733
	VISIT DATE: 02/13/2023

NARRATIVE

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Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoptions of new laws, pay annual fees etc.

LPA discussed the safe sleep regulations with Licensee and provided information regarding the regulations and a copy of the LIC 9227. LPA discussed the safe sleep regulations with Licensee and 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.

Licensee states that she does not administer any medications to the day care children at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.
The 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.

Exit interview conducted and report was reviewed with the Licensee, Leoni Capistrano.

One Type B Deficiency is being cited based on LPA's observations, interviews conducted and records reviewed in accordance with the California Code of Regulations Title 22. Appeal rights will be emailed to the licensee.

Due to technical difficulties with printer LPA will email copy of the facility inspection to Licensee once at the office.

A NOTICE OF SITE VISIT WILL BE PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/17/2023 10:45 AM - It Cannot Be Edited

Created By: Farida Raja On 02/13/2023 at 11:23 AM

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: CAPISTRANO, LEONIE	FACILITY NUMBER: 434402733
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reported training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above. Licensee does not have a current Mandated Reporter Training (expired in 01/29/2022) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/13/2023
	Plan of Correction
1 2 3 4	Licensee stated that she will submit a copy of the Mandated Reporter Training by the POC date.

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: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC809 (FAS) - (06/04)

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