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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434405944
Report Date: 07/16/2021
Date Signed: 07/16/2021 02:05:06 PM

Document Has Been Signed on 07/16/2021 02:05 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:VARGAS, GRACIELAFACILITY NUMBER:
434405944
ADMINISTRATOR:VARGAS, GRACIELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 275-1689
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
07/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Graciela VargasTIME COMPLETED:
01:05 PM
NARRATIVE
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LPA Anna Morales conducted an unannounced Annual/Required Inspection ( Tool Kit One) LPA met with Licensee, Graciela Vargas. Also present was Licensee's daughter (over 18 years of age) who was assisting her with the supervision of the children. LPA observed eight children playing outside. Licensee stated that she has eight children (2 yrs to 6 yrs old). She stated that there are no children under twelve months old. LPA reviewed a current copy of Children's roster. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. Last Disaster Drill was conducted on May 28,2021.

Beside Licensee residing at this location, are her two daughters and son, all over the age of 18 years old. They all have Criminal Background Check Clearances, signed Criminal Record Statements LIC508 on file with Licensing Office.

LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Outdoor activity space is enclosed by fencing and is observed to be free of hazards. LPAs observed play equipment were in good condition. LPA's observed resilient materials under the climbing structures. Drinking water was readily available to children indoor and outdoor. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters inside the home. Off-limit areas inside: the entire upstairs of the home (master bedroom and bathroom) and two additional bedrooms. Off-limit areas outside: the garage. Observed barricade in front of stairs.
LPA observed a fully charged 3A40BC fire extinguisher and working smoke/carbon monoxide detectors,. The Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.
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SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2021
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: VARGAS, GRACIELA
FACILITY NUMBER: 434405944
VISIT DATE: 07/16/2021
NARRATIVE
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Website for provider resources & licensing updates: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov

LPA conducted an exit interview with the Licensee prior to the conclusion of today's inspection and the Licensee agreed to submit copies of Mandated Reporter for herself and a copy of the Children's roster.

No deficiencies issued during today's inspection.

LPA discussed and left a copy of Pin 20-24-CCP, RECENTLY APPROVED SAFE SLEEP REGULATIONS IN EFFECT. Discussed that all INFANTS UP TO 12 MONTHS OF AGE MUST HAVE AN INDIVIDUAL INFANT SLEEPING PLAN (LIC9227) OF FILE, WHICH WILL DOCUMENT THE INFANTS SLEEPING HABITS, USUAL SLEEPING ENVIRONMENT, AND THE INFANT ROLLING ABILITIES.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

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SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
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: VARGAS, GRACIELA
FACILITY NUMBER: 434405944
VISIT DATE: 07/16/2021
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LPA reviewed a random selection of Emergency Information Cards(LIC700) and they were complete and updated.

Incidental Medical Services (IMS) policy was discussed. The Licensee stated that she does not have take care of children who are ill. 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. Licensee has an area where sick children can be isolated from the others

LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who comes in contact with or provide care and supervision to the children. 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.

Licensee has current Mandated Reporter Certificate. The last Mandated Reporter Certificate expires for Licensee 8/29/22 and her assistant on 8/30/2022. LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with applicant Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed atwww.mandatedreporterca.com.

Licensee does have current CPR and First Aid card. It expires on 10/2022
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC809 (FAS) - (06/04)
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