434403988-3-15-2023-07-CC-FRAA-CPXTNH-20230315145246

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434403988
Report Date: 03/15/2023
Date Signed: 03/15/2023 02:54:57 PM

Document Has Been Signed on 03/15/2023 02:54 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	VILLALOBOS, SILVIA		FACILITY NUMBER:	434403988
ADMINISTRATOR:	SILVIA VILLALOBOS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 876-8807
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 2	CENSUS: 0	DATE:	03/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Silvia Villalobos		TIME COMPLETED:	03:05 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	Licensing Program Analysts (LPAs), Farida Raja and Marilou Monico, conducted an unannounced 1- year annual inspection. LPAs were granted access to the home by Licensee, Silvia Villalobos, and explained the nature of today’s inspection. LPAs observed only Licensee and no children in the home during today’s inspection. Licensee stated that she currently provides overnight care to 2 children (11 & 12 year olds) from 9 pm to 7 am. Days and hours of operation are Monday to Sunday 9:00 am to 8:00 am. LPAs observed all required posted materials, including facility license, Notification of Parents' Rights and Earthquake Preparedness near the front entrance to the home. The licensee is the only adult residing in the home. LPAs toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408-876-8807). LPAs inspected home for any health and safety hazards. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating for safety and comfort. A thermostat was observed. LPAs observed age-appropriate materials, toys, and play equipment in the facility. The home is single story with a gate separating the living room and off limits bedroom. Off limit areas inside the home: master bedroom, master bathroom, entertainment room, attached garage and barricaded fireplace in the living room of the home. There are no stairs or wall heater units inside the home. Off limit areas outside the home: left side section of the backyard and right side BBQ area. Backyard is fenced and both sides of the home are gated. There are no bodies of water. LPAs observed a fully charged 3A40BC fire extinguisher in the on limits bedroom area and working smoke/carbon monoxide detectors. The Licensee states that she does not have any weapons. Licensee has 2 dogs, 2 birds and some turtles in the home. All detergents, cleaning compounds, medications, sharp objects and other similar items are stored inaccessible to children in high kitchen cabinets. LPAs observed the bathroom used by children was in operating condition. Toilets and faucet are sanitary and operable. The shower area is free on any hazards.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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: VILLALOBOS, SILVIA	FACILITY NUMBER: 434403988
	VISIT DATE: 03/15/2023

NARRATIVE

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Drinking water is readily available for children in the home. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated. Licensee states that she does not provide any meals/snacks to children.

LPAs reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was conducted on 12/23/2022. LPAs obtained a picture of the children's roster. Children file review was completed and found to be current and up to date. Two (2) 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 Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282).

LPAs discussed the safe sleep regulations with Licensee, including documentation that shall be maintained and conducting 15-minute checks on all sleeping infants. LPAs 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.

LPAs reviewed licensee's file which was complete with the required forms. Licensee has current Pediatric CPR/First Aid certification with an expiration date of 01/07/2025. Licensee has proof of immunization in file for measles, pertussis, TB clearance and statement declining influenza. Licensee has Mandated Reporter Training which expires on 03/14/2024.

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

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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: VILLALOBOS, SILVIA	FACILITY NUMBER: 434403988
	VISIT DATE: 03/15/2023

NARRATIVE

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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.

LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty and $100 per day violation until corrected 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.

Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov/ www.ccld.ca.gov to access resources for providers, regulations, adoptions of new laws, pay annual fees etc.

Licensee states that a child will be isolated in an off limit bedroom if necessary due to illness or communicable disease. 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 Americans with Disabilities Act (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.

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, Silvia Villalobos.

As a result of today's inspection, there were no deficiencies cited. Appeal rights were printed and given to Licensee.
A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC809 (FAS) - (06/04)

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