434407664-6-13-2024-07-CC-FRAA-D67LUE-20240613090349

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434407664
Report Date: 06/12/2024
Date Signed: 06/13/2024 09:03:58 AM

Document Has Been Signed on 06/13/2024 09:03 AM - 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:	GALSIM, MARIBEL		FACILITY NUMBER:	434407664
ADMINISTRATOR/ DIRECTOR:	GALSIM, MARIBEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 528-7340
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 11	CENSUS: 7	DATE:	06/12/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:13 AM
MET WITH:	Maribel Galsim		TIME VISIT/ INSPECTION COMPLETED:	02:35 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	On 06/12/2024 at 11:13 am, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced annual/random inspection. LPA was granted access to the home by Licensee's sister, Janalin Pimentel and explained the nature of today’s inspection. Janalin stated that Licensee has gone for an appointment and called to inform her of LPA's visit. Licensee arrived at 11:36 am. Present during the inspection were Licensee, Licensee's sister/staff- Janalin Pimentel, Licensee's mother/staff - Mila Pimentel and 7 preschool children. Licensee was operating within the ratio and capacity requirements of the license. Days and hours of operation are Monday to Friday, 7:00 am to 6:00 pm. LPA observed all required posted materials in the on limit family room of the home. There are eight adults that reside in the home. They include licensee, spouse, mother, two sisters, son, son’s girlfriend and nephew. A review of records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408-806-6358). LPA observed sufficient materials, toys, and play equipment for the day care children. There were no baby walkers or bouncers observed on the premise during today’s inspection. The home has central heating/cooling and ventilation for comfort of children. The home is two story and LPA observed barricaded stairs to the upper level and to the family room during today's inspection. Off limit areas inside the home: entire second level, kitchen, downstairs bedroom, living room, attached garage and barricaded fireplace in the on limit family room area. On limit areas include family room and attached half bath. The bathroom used by children is in operating condition. Toilets and faucet are clean and operable. Off limit areas outside the home: left and right side gated sections of the backyard. Backyard is fenced. No bodies of water were observed. LPA observed some play structures in the backyard that are safe and secure for the children. LPA observed a locked area in the backyard that Licensee stated is used for storage. Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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: GALSIM, MARIBEL	FACILITY NUMBER: 434407664
	VISIT DATE: 06/12/2024

NARRATIVE

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LPA observed a fully charged 3A40BC fire extinguisher in the kitchen area and working smoke/carbon monoxide detectors in the family room. LPA reminded Licensee that fire extinguisher needs to be serviced once in 12 months. Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, poisons, medications, sharp objects and other similar items were observed to be stored inaccessible to children. Licensee understands that smoking is prohibited in the home.

Drinking water is readily available for children in the home via individual water bottles and water dispensers. LPA observed water dispensers both indoors and outdoors with disposable cups. Licensee states that parents bring all meals for the day care children. Licensee stated that she sometimes provides snack to the children and is aware of any food allergies that children may have. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated. Licensee stated that a child will be isolated in the living room if necessary due to illness or communicable disease.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was last conducted on 03/12/2024. LPA obtained copy of children's roster. LPA reviewed seven (7) children’s files during today's inspection. Licensee does not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). Licensee is not caring for any children under 2 years of age at this time.

LPA discussed the safe sleep regulations with licensee, including conducting 15-minute checks on all sleeping infants 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 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.

Staff file review was completed and found to be current and up to date. LPA reviewed three(3) staff files (Licensee and two adult assistants) and the files were complete with the required forms. Licensee and staff have Pediatric CPR/First Aid certification which expires on 04/08/2025. Licensee and both staff have proof of immunization in file for measles, pertussis and influenza. Licensee and staff are current with Mandated Reporter Training for Child Care Workers.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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: GALSIM, MARIBEL	FACILITY NUMBER: 434407664
	VISIT DATE: 06/12/2024

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the requirement for Licensee to be present at the facility 80 percent of the hours the facility is in operation and that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. Licensee stated that she understands. 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 will submit an updated facility sketch (LIC 999) including a sketch for the off limits second level and an updated Emergency Disaster Plan (LIC 610A) to LPA by 06/28/2024.

LPA discussed "zero tolerance" related regulations which includes the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty 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. 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 https://cdss.ca.gov/inforesources/child-care-licensing to access general updates, resources for providers, regulations, adoptions of new laws, pay annual fees etc. Department will communicate all new information to providers through Provider Information Notices (PINs). Please sign up to be notified for new PINs at www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and visit the Department’s website for the latest PINs.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GALSIM, MARIBEL	FACILITY NUMBER: 434407664
	VISIT DATE: 06/12/2024

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. Licensee stated that she does not dispense medication to children at her facility. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensees stated that she provides 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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

As a result of today's inspection, there were no deficiencies cited. Exit interview conducted and report was reviewed with the licensee, Maribel Galsim.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC809 (FAS) - (06/04)

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