434405916-8-18-2022-07-CC-TTRO-CHEQTT-20220818122740

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434405916
Report Date: 08/18/2022
Date Signed: 08/18/2022 12:27:55 PM

Document Has Been Signed on 08/18/2022 12:27 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:	DELGADO, MARIA DE LOURDES		FACILITY NUMBER:	434405916
ADMINISTRATOR:	DELGADO, MARIA DE LOURDES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 274-7543
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95121
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 7	CENSUS: 7	DATE:	08/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Maria De Lourdes Delgado		TIME COMPLETED:	12:35 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), Teodoro Trujillo and Fermin Campos-Jaramillo, met with Licensee, Maria De Lourdes Delgado, for an unannounced Required - 1 Year Inspection. LPAs were granted access to the home by the Licensee and toured both indoor and outdoor areas during the inspection. Also present in the home was a assistant Yaneth Barajas, 1 infant and 6 preschool children. LPA observed all required posted materials. Days and hours of operation for the facility are Monday – Sunday, 6:00 AM- 6:00 PM. Licensee is serving children ages 0 years to 12 years old. There are no active waivers or exceptions for this facility. Licensee states that there are two adults residing in the home: herself and her husband. Licensee Maria De Lourdes Delgado 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. LPAs reviewed and obtained copy of facility roster (LIC9040). Fire/disaster drill was conducted on July 11, 2022. LPA observed a fully charged 3A40BC fire extinguisher, no fireplace, and functioning smoke and carbon monoxide detectors. Licensee states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. Licensee states that there are no weapons or firearms in the home. Continuation on next pages

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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: DELGADO, MARIA DE LOURDES	FACILITY NUMBER: 434405916
	VISIT DATE: 08/18/2022

NARRATIVE

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Indoor licensed areas of the facility were inspected by LPA today and observed to be clean, orderly, and safe for the day care children. LPAs observed that there are no wall heaters. Off-limits areas in the home include indoor: living room, master bedroom, master bathroom, three bedrooms, kitchen, and laundry area. . LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. The floors were clean and free of tripping hazards. Drinking water is readily available for children in the facility via filtered water and individual water bottles from home. The bathroom in the home is clean, sanitary, and operable. The Licensee has a working telephone in the facility.

The outdoor licensed areas of the home was inspected and observed to be fenced in. Off limit areas outside the home include: two locked storage sheds and fenced off area. LPA observed a locked storage unit in the off limits area. There were no bodies of water observed.

Seven (7) children’s files were reviewed during todays inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Affidavit Regarding Liability Insurance (LIC 282), and Immunization Records (PM286).

Licensee's Mandated Reporter Training for Child Care Providers expires on June 16, 2024, Assistants Yaneth Barajas expired on June 05, 2022. Mandated Reported Training can be accessed at www.mandatedreporterca.com. Licensee's and assistant CPR/First-Aid expires on June 1, 2024. LPAs reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years.

Continued on next page.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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: DELGADO, MARIA DE LOURDES	FACILITY NUMBER: 434405916
	VISIT DATE: 08/18/2022

NARRATIVE

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Supervision of children was discussed with the Licensee and she understands that children are supervised at all times. The Licensee states that she does not transport any day care children. LPA reminded Licensee that 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. LPAs reminded licensee about the capacity options of her license.

LPAs 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.

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

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.

Exit interview conducted and report was reviewed with the licensee Maria De Lourdes Delgado.

One type B deficiencies was cited today.

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

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/18/2022 12:27 PM - It Cannot Be Edited

Created By: Teodoro Trujillo On 08/18/2022 at 11:50 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: DELGADO, MARIA DE LOURDES	FACILITY NUMBER: 434405916
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/18/2022

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 observaton of staff record, the licensee did not comply with the section cited above in assistant Yaneth Guerro expired Mandated Reporter Training on 06/05/2022, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/02/2022
	Plan of Correction
1 2 3 4	Assistant will renew and subit by fax, mail or E-mail to the San Jose Child Care Licensing Office a copy of completed Mandated Reporter certificate on or before 09/02/2022.

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:

Mary Segura

LICENSING EVALUATOR NAME:

Teodoro Trujillo

LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC809 (FAS) - (06/04)

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