434402733-4-17-2024-07-CC-FRAA-D4ELQW-20240417085814

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434402733
Report Date: 04/15/2024
Date Signed: 04/17/2024 08:58:22 AM

Document Has Been Signed on 04/17/2024 08:58 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/ DIRECTOR:	LEONIE CAPISTRANO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 274-3046
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 7	CENSUS: 6	DATE:	04/15/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:15 PM
MET WITH:	Leonie Capistrano		TIME VISIT/ INSPECTION COMPLETED:	03:50 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 04/15/2023 at 12:15pm, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced annual inspection. LPA was granted access to the home by Licensee, Leonie Capistrano and explained the nature of today’s inspection. Present in the home were licensee and six children including four preschool age and two infants. Licensee was operating within the ratio and capacity requirements of the license. Days and hours of operation are Monday to Friday, 7:30 am to 5:30 pm. LPA observed all required posted materials near the front entrance to the home. Per Licensee, she and spouse are the only adults that reside in the home. Licensee has 4 minor children residing in the home. Licensee has a 17 year old that will turn 18 this year. LPA informed Licensee that child needs to be fingerprinted within 30 days once they are 18 years of age. Licensee understands that she needs to maintain fingerprint clearances and proof of tuberculosis test for all adults 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 (408-823-8553). 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 floors were free of tripping hazards with toys put away. The home has central heating and wall air conditioning unit for comfort of children. The daycare has a separate entrance to the right of the main entrance to the home. The home is two story and stairs were observed barricaded stairs during today's inspection. Off limit areas inside the home: entire upper level, kitchen, living room, dining room, office, laundry area, bathroom and attached garage. Licensee stated that the sun room is used occasionally during music time. Off limit areas outside the home is the left side section of the backyard. Backyard is fenced. The outdoor space and play equipment were observed to be age appropriate. Licensee stated that the backyard is not in use at this time and children use the gated front yard for outdoor time. There are no bodies of water observed. LPA informed Licensee to submit an updated facility sketch indicating room sizes including a sketch for the upper level and yard of the home by 04/29/2024. LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

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: CAPISTRANO, LEONIE	FACILITY NUMBER: 434402733
	VISIT DATE: 04/15/2024

NARRATIVE

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LPA observed a fully charged 3A40BC fire extinguisher in the kitchen area and working smoke/carbon monoxide detectors. Licensee states that she does not have any weapons in the home. Licensee has one pet dog. All detergents, cleaning compounds, poisons, medications, sharp objects and other similar items were observed to be stored inaccessible to children. Licensee understands that smoking is prohibited in the home.

Drinking water is readily available for children in the home via individual water bottles/water cups. Licensee states that she provides meals and snacks to the children in care. Licensee stated that parents provide meals and snack if child has any specific dietary restrictions. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated. Licensee states that a child will be isolated in the other daycare room if necessary due to illness or communicable disease.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was last conducted on 1/15/2024. LPA obtained copy of children's roster.

Six (6) children’s files were reviewed during today's inspection. Licensee carries daycare insurance and LPA observed a current policy verifying valid coverage. LPA reviewed two (2) infant's files and did not observe 15-minute nap check log. During interview with Licensee, Licensee stated that she had begun the 15 minute nap checks for infants but had discontinued them. LPA reminded Licensee that as per Safe Sleep regulations 15-minute nap checks need to be conducted for all children under 2 years of age and documented. During today's inspection, LPA observed two infants (C1 and C3) were placed to sleep on the floor with barricades/gates around their beds. Licensee stated that the infants can climb our of the crib and are therefore placed on the floor but as they walk around and disturb other children a baby gate/barricade is placed around their beds. LPA advised Licensee that the barricade cannot be placed around a child's bed to restrict their movements. Licensee stated that she understood and removed the barricades during today's inspection.

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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

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: CAPISTRANO, LEONIE	FACILITY NUMBER: 434402733
	VISIT DATE: 04/15/2024

NARRATIVE

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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.

LPA reviewed Licensee's file for the required forms and found them to be current and up to date. 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.

Licensee has current Pediatric CPR/First Aid certification that expires on 7/12/2024 and Mandated Reporter Training that expires on 03/10/2025. Licensee has 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. 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.

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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

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: CAPISTRANO, LEONIE	FACILITY NUMBER: 434402733
	VISIT DATE: 04/15/2024

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. LPA informed Licensee of the requirement to submit an Incidental Medical Plan and provided Licensee with a copy of PIN 22-02-CCP. Licensee will submit an IMS Plan to LPA by 04/29/2024. 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 are available at: https://www.ada.gov/resources/child-care-centers/.

Licensee states that she does not provide transportation to daycare children at this time. 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. Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing updates and regulations.

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.

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.

One Type B deficiency and one technical violation were cited during today's inspection. Appeal rights were printed and provided to Licensee. LPA reminded Licensee that failure to correct deficiencies by Plan of Correction Due Date may result in civil penalties.Exit interview conducted and report was reviewed with the licensee, Leonie Capistrano.

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

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/17/2024 08:58 AM - It Cannot Be Edited

Created By: Farida Raja On 04/15/2024 at 02:58 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: CAPISTRANO, LEONIE	FACILITY NUMBER: 434402733
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above for two infants (C1 and C3) which poses a potential health, safety or personal rights risk to persons in care. Licensee stated that she had begun conducting 15 minute sleep checks and documenting them but had discontinued to do so. LPA reminded Licensee that all infants under 2 years of age need to be physically checked every 15 minutes. Nap log shall be completed as checks are done on the infant.
	POC Due Date: 04/29/2024
	Plan of Correction
1 2 3 4	Licensee will conduct and log sleep checks and submit proof to LPA for infants C1 and C3 by plan of correction date of 04/292/2024.

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: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

LIC809 (FAS) - (06/04)

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