434404273-4-28-2023-07-CC-FRAA-CRBQUZ-20230428122934

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404273
Report Date: 04/27/2023
Date Signed: 04/28/2023 12:29:44 PM

Document Has Been Signed on 04/28/2023 12:29 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:	SANDOVAL, MAYRA		FACILITY NUMBER:	434404273
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 5	CENSUS: 0	DATE:	04/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Mayra Sandoval		TIME COMPLETED:	11:55 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 Analyst (LPA), Farida Raja, conducted an unannounced 1- year annual inspection. LPA was granted access to the home by Licensee, Mayra Sandoval, and explained the nature of today’s inspection. There were no children in the home today as Licensee only cares for school age children that come before and after school. Licensee stated that she is planning some renovation work and submitted an Unusual Incident Report during today's inspection. Days and hours of operation are Monday to Friday, 7:00 am to 5:00 pm. LPA observed all required posted materials, near the front entrance to the home. The adults that reside in the home are Licensee, Husband- Roberto Sandoval, Son- Roberto Sandoval and Daughter- Gabriella Sandoval. LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408-807-1736). Licensee provides care only to school age children at present. LPA observed sufficient materials, toys, and games for the day care children. The home has central heating/cooling and ventilation for comfort of children. The home is single story. Off limit areas inside the home: master bedroom, master bathroom, two bedrooms, kitchen and laundry area. Due to the planned construction work all toys and play equipment has been stored in the den and children are only using the living room at present. There are no stairs or wall heater units inside the home. Off limit areas outside the home: gated right side section including 2 storage sheds. Backyard is fenced and both sides of the home are gated. There are no bodies of water. LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. LPA observed a fully charged 3A40BC fire extinguisher in the kitchen area and working smoke/carbon monoxide detectors. The Licensee states that she does not have any weapons in the home. Licensee has one pet and has record of current vaccinations. All detergents, cleaning compounds, medications, sharp objects and other similar items are stored inaccessible to children. Licensee has a first aid kit in the living room area in high cabinets. Licensee understands that smoking is prohibited in the home.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

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: SANDOVAL, MAYRA	FACILITY NUMBER: 434404273
	VISIT DATE: 04/27/2023

NARRATIVE

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Drinking water is readily available for children in the home via individual water bottles. Licensee states that she provides meals and snack and also allows food from home. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated. Licensee uses the Catalyst Community Child Care Food Program.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was conducted on 11/14/2022. LPA obtained copy of children's roster. Children file review was completed and found to be current and up to date. Five (5) children’s files were reviewed during today's inspection. Licensee states that she does not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). LPA discussed the safe sleep regulations with Licensee, including documentation that shall be maintained and conducting 15-minute checks on all sleeping infants. LPA 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. LPA provided licensee with a copy of an Individual Infant Sleeping Plan (LIC 9227) and a sample 15- minute sleeping infant check form. Licensee has no infants in care at this time.

LPA reviewed licensee's records which was complete with the required forms. Licensee has current Pediatric CPR/First Aid certification with an expiration date of 03/25/2025. Licensee has proof of immunization in file for measles, pertussis and influenza, according with the SB792. Licensee's Mandated Reporter Training expires on 03/13/2025. 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 8 children in the home at any time.

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.

LPA discussed "zero tolerance" related regulations with Applicant and advised her of the assessment of an

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

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: SANDOVAL, MAYRA	FACILITY NUMBER: 434404273
	VISIT DATE: 04/27/2023

NARRATIVE

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immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

Licensee is encouraged to visit the Department’s website at 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 the living room 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.

Licensees states that she does provide transportation to school age children. LPA reminded Licensee that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.

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@dess.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.

Exit interview was conducted and report was reviewed with the Licensee, Mayra Sandoval.

As a result of today's inspection, there were no deficiencies cited.

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: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC809 (FAS) - (06/04)

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