434402733-1-9-2025-07-CC-PSGZ-DCRQ8T-20250109105715

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434402733
Report Date: 01/09/2025
Date Signed: 01/09/2025 10:57:31 AM

Document Has Been Signed on 01/09/2025 10:57 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 CC RO, 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: 8	CENSUS: 7	DATE:	01/09/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Leonie Capistrano		TIME VISIT/ INSPECTION COMPLETED:	11:15 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 (LPAs) Pedro Solorio Gutierrez & Farida Raja met with Licensee Leonie Capistrano for an annual/random visit. LPAs disclosed the purpose of today’s inspection. Present were Licensee Leonie Capistrano, Staff Kimchhuon, and 7 day care children including 2 infants and 5 preschool age. Days and hours of operation are Monday to Friday, 07:30am to 05:30pm. The three adults that reside in the home are licensee Leonie Capistrano, Spouse Paul Capistrano, Caleb Capistrano (son), and 3 minor children. A review of staff records on 1/9/2025 indicated that all facility staff or individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee son turned 18 and upon review of the livescan form licensee has not obtained child abuse index clearance. LPAs advised Licensee to verify clearance by contacting the San Jose Regional office and correctly completing the Live Scan form. Licensee Leonie 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. 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. Licensee submitted an update application (LIC 279). LPAs inspected the indoor and outdoor areas during this inspection. LPAs did not observe bodies of water. There is fencing/ are walls in the backyard. LPAs observed that the home is clean and orderly, with heating and ventilation for safety of children. LPAs observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items inside the residency are stored and inaccessible to children. LPAs observed a fully charged 3A40BC fire extinguisher and reminded licensee that it has to be serviced every year. A working combo smoke and carbon monoxide detector was located and tested. Licensee states that there are no weapons/firearms in the home. Off limit areas indoor: garage, office room, living room, dining room, sun room/ music room, kitchen, downstairs bathroom, laundry room, and all of the 2^nd floor. Off limits outdoor: right and left side areas, including storage. Licensee states that there are animals in the home - 1 dog. Licensee has valid daycare insurance.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Pedro Solorio-Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CAPISTRANO, LEONIE	FACILITY NUMBER: 434402733
	VISIT DATE: 01/09/2025

NARRATIVE

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LPAs observed licensee has a current CPR and First Aid Certification expiring 8/23/2026 and Mandated Reporter training expires on 3/10/2025. LPAs did observe a current children roster. LPAs observed a Fire/Disaster drill log during today’s visit that was conducted on 7/11/2024. LPAs reviewed 4 of children’s files and observed all required documents including 15 minute nap checks. IMS is administered by the Facility – Epipen was inspected and not expired. This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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-carecenters/.

Supervision of children was discussed and understood that licensee must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands the capacity. Licensee understands that if children are transported via vehicle, children cannot be left in parked vehicles unattended at any time.

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.

Licensee Leonie 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.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Pedro Solorio-Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CAPISTRANO, LEONIE	FACILITY NUMBER: 434402733
	VISIT DATE: 01/09/2025

NARRATIVE

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LPAs discussed the safe sleep regulations with licensee Leonie and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPAs also informed licensee Leonie 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.

Licensee Leonie 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, the LICENSEE LEONIE CAPISTRANO, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

One Type B deficiency and one technical violation issued as a result of today's inspection. Appeal rights provided. An exit interview was conducted and report was reviewed with licensee Leonie Capistrano.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Pedro Solorio-Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/09/2025 10:57 AM - It Cannot Be Edited

Created By: Pedro Solorio-Gutierrez On 01/09/2025 at 10:28 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: 01/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(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 reporter 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 (interview) (record review), the licensee did not comply with the section cited above for one staff (S2) which poses a potential health, safety or personal rights risk to persons in care. Upon file review, LPAs observed staff S2's Mandated Reporter training has expired.
	POC Due Date: 01/23/2025
	Plan of Correction
1 2 3 4	Licensee to have staff complete the training and submit proof to LPA by plan of correction date of 01/23/2025.

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:

Joel Segura

LICENSING EVALUATOR NAME:

Pedro Solorio-Gutierrez

LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

LIC809 (FAS) - (06/04)

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