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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434403137
Report Date: 10/20/2022
Date Signed: 10/20/2022 12:22:40 PM

Document Has Been Signed on 10/20/2022 12:22 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SAUCEDO, ANAFACILITY NUMBER:
434403137
ADMINISTRATOR:SAUCEDO, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 238-0960
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
10/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:Saucedo, AnaTIME COMPLETED:
01:00 PM
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Licensing Program Analysts (LPA) Almaraz, Celi met with Saucedo, Ana for an unannounced Required – 1-year annual inspection. LPA was granted access to the home by the Licensee. LPAs also observed two children (toddlers) and no other adults. Licensee was operating within her capacity and ratio requirements. LPAs observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 7:00 AM to 5:00 PM. The adults residing in the home are: Licensee and Licensee's spouse Saucedo, Carlos and daughter Saucedo, Isis.

Facility Records: LPAs reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on 09/08/2022. Licensee states that she does have liability insurance for the day care through DCI Insurance and LPA observed a valid policy verifying coverage.

Licensee has current CPR and First Aid certifications (expiration:5/22/2024)). Licensee has the required vaccines (MMR, Tdap & opt out for flu. Licensee is current with her Mandated Reporter Training for Child Care Workers (expiration: 09/22/2023). Licensee has the required vaccines (MMR, Tdap, & flu) and is current with the Mandated Reporter Training for Child Care Workers (expiration: 11/12/2023). LPA reviewed two children's files and the files were complete with the required forms. LPA reviewed staff files and the files were complete with the required forms. 1/4
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SAUCEDO, ANA
FACILITY NUMBER: 434403137
VISIT DATE: 10/20/2022
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Physical Plant: LPAs observed the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home. The home is clean, orderly, (including heating/air conditioning/ventilation), and safe for the day care children. There is safe & age appropriate toys, play equipment, and materials for the children in the home. Off limit areas inside the home: Attached studio where daughter resides, bedroom 1,3 and 4. Off limit areas outside the home: The left and back side of the yard, fenced to prevent child access, within the fencing there is a storage shed with a lock. LPAs observed a fully charged 3A40BC fire extinguisher serviced 02/11/2022, working smoke/carbon monoxide detectors, no bodies of water, and fully fenced backyard. The Licensee states that there is one pet, vaccinated. There are no weapons in the home, wall heaters, fireplaces. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Licensee states that there are no poisons in the home. There is an updated facility sketch sent to licensing office on 01/2022, indicating addressing changes to the home. Licensee states that there is currently no administering of any medications to the day care children. Licensee states that nobody smokes and understands that smoking is prohibited in the home. There are no stairs in the home. Safety knobs for off limit rooms was discussed, for when older children are in care.
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
Supervision of children was discussed with the Licensee and licensee understands that there must be a cleared adult must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands capacity/ratio options and understands that there cannot be more than 14 children present in the home without two qualified adults present. 2/4
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SAUCEDO, ANA
FACILITY NUMBER: 434403137
VISIT DATE: 10/20/2022
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 Licensee states that a child will be isolated in the living room area if necessary due to illness or communicable disease. Licensee states that there transporting day care children. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping. 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. 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 requested to remove Alejandro Arreola ID 7517581404 from facility roster.

LPAs discussed the safe sleep regulations with the 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. LPA also informed the 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.LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was discussed. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained. A review of PIN 20-24-CCP Recently approved Safe Sleep Regulations in Effect was discuss and a copy was provided to the Licensee during this inspection. Licensee currently does not enroll children under 2 years old.

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 3/4

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SAUCEDO, ANA
FACILITY NUMBER: 434403137
VISIT DATE: 10/20/2022
NARRATIVE
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SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee. The following was discussed:
· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearance prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
· The Licensee shall be present in the home and shall ensure that children are supervised at all times.
· Children shall not be left in park vehicles.
· The capacity specified on the license shall be the maximum number of children for whom care can be provided.
· Car seats shall only be used for transportation purposes and shall not be used for sleeping.
· All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
· When a child shows signs of illness, they will be separated from other children until the nature if the illness is determined.
· Personal rights must be accorded to the children in care.
· Reporting requirements.

LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home. CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children’s records requirements, mandated child abuse and injury/death reporting, and criminal record transfer requirements were discussed.
At this time, there were no deficiencies cited during today’s inspection.

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

Exit interview conducted and report was reviewed with facility representative. 4/4

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC809 (FAS) - (06/04)
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