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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410139
Report Date: 05/28/2025
Date Signed: 05/28/2025 03:28:28 PM

Document Has Been Signed on 05/28/2025 03:28 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:DE PIEROLA, ERIKAFACILITY NUMBER:
434410139
ADMINISTRATOR/
DIRECTOR:		ERIKA DE PIEROLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 369-1806
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
05/28/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Erika de PierolaTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 5/28/25 at 1:05PM, Licensing Program Analyst (LPA) Angela Luz met with Licensee Erika de Pierola to conduct an unannounced annual RANDOM inspection. Also present for this inspection was 9 children (1 infant and 8 preschool aged children) and 1 fingerprint cleared assistant. The home was toured to conduct a Health and Safety Inspection. Days and hours of operation are Monday – Friday 7:30AM-6:00PM. English and Spanish are spoken to the children in care. Licensee’s preferred language is English.

Facility: Assistant toured the facility with LPA. The ON LIMIT AREAS are the kitchen, living room, family room, bedroom 3, and the grass/turf areas of the backyard. The kitchen is used for hand washing only. The OFF LIMIT AREAS are bedrooms 1, 2, and 4; front yard, and side of the backyard. Off limit areas are inaccessible by closed and/or locked doors and visual supervision. The home is neat and clean with heating and ventilation for safety and comfort. LPA observed a barricaded fireplace. The ISOLATION AREA is the couch or kitchen. The outdoor play area is free from defects or dangerous conditions and is fully fenced. LPA observed a large, sturdy structure in the backyard with turf underneath. LPA observed a resilient material was present under the turf in the slide, swing, and climbing areas of the structure.

There have been no changes from the areas previously identified as OFF LIMITS or alterations to existing building or grounds. There are no bodies of water. All hazardous materials and toxins are kept out of the reach of children. Licensee understands that any materials that are labeled “Keep out of reach of children” or have similar messaging should be kept out of reach from children in care. Licensee states that there are no firearms in the home. The home has a fully charged 3A40BC fire extinguisher that was last serviced on 2/4/25, working smoke detector, working carbon monoxide detector, and working telephone. LPA reminded that fire extinguishers should be serviced once a year.
NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Angela Luz
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DE PIEROLA, ERIKA
FACILITY NUMBER: 434410139
VISIT DATE: 05/28/2025
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Care and Supervision: There are ample age-appropriate toys that appear to be safe and in good condition. Licensee uses redirection and talking with the child as forms of discipline. Licensee understands that children's personal rights should not be violated, including but not limited to, no corporal punishment, interference with eating, intimidation, or other actions of a punitive nature. Children are treated with dignity, receive safe, healthful, and comfortable accommodations. LPA reminded that Licensee is required to be present for 80% of operating hours per day. Licensee understands how to report Unusual Incidents/Injuries.

LPA observed 6 play yards. The play yards do not hinder entrance or exit to and from the space where infants are sleeping. The product warning label for the play yard states to only use the mattress pad provided. The mattress pad in the play yards are firm and covered with a fitted sheet that is appropriate and overlaps the underside of the mattresses. LPA reminded Licensee to ensure the sheets fit tightly on the mattress pad. Each infant’s bedding is used for them only and cleaned weekly or before use by another infant. There are no bumper guards or objects hanging above or attached to the side of the play yards. LPA observed preschool aged children sleeping in the play yards with blankets on them. LPA reminded Licensee that loose articles or objects, including blankets, should not be in the play yards while children are sleeping. LPA advised that if preschool aged children want to use blankets, transition them to sleeping on cots. LPA reviewed and gave copies of PIN 20-24-CCP and Title 22 Section 102425 Infant Safe Sleep with Licensee. Licensee understands Infant Safe Sleep requirements.

Records: Licensee CPR and First Aid certificate is current and expires 6/5/26. Licensee Mandated Reporter Training for Child Care Providers is current and expires 10/15/26. Licensee was reminded Mandated Reporter Training (AB1207) and CPR/First aid certifications needs to be renewed every two years. A copy of the licensee’s immunization is on file. The Licensee conducts and documents fire and disaster drills every six months, last drill was on 1/7/25. A current copy of the facility roster was viewed, and a copy was obtained. Licensee does not carry liability insurance and Affidavit Regarding Liability Insurance (LIC 282) were found in children’s files. Entrance checklist for Family Child Care Home was provided and licensee was reminded of documents to be posted in a prominent, publicly accessible area of the facility.

LPA reviewed two (2) staff (S1-S2) files for the following records: Employee rights (LIC 9052), Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), immunization records, and required training. Staff files were complete.
NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Angela Luz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
LIC809 (FAS) - (06/04)
Page: 3 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DE PIEROLA, ERIKA
FACILITY NUMBER: 434410139
VISIT DATE: 05/28/2025
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LPA reviewed nine (9) children files 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 Immunization records. Preschool aged children files reviewed were complete. The reviewed infant file was missing documentation of infant sleep checks every 15 minutes that notate any signs of distress. Licensee showed LPA how they were documenting infant sleep checks for infants 0-12 months old. LPA reminded Licensee that documentation of infant sleep checks is required for all infants 0-24 months old.

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.

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 safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

Incidental Medical Services (IMS) policy was discussed. 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/.
NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Angela Luz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
LIC809 (FAS) - (06/04)
Page: 4 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DE PIEROLA, ERIKA
FACILITY NUMBER: 434410139
VISIT DATE: 05/28/2025
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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, the LICENSEE, Erika de Pierola, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Megan's Law was checked on 5/27/25.

No deficiencies are issued today.
3 advisory notes are issued.
  • Fitted sheets on mattress pads should fit tightly.
  • Cribs or play yards shall be free from all loose articles and objects.
  • Documentation of infant sleep checks that notate any signs of distress are required for all infants 0-24 months old.

Appeal rights were provided.

A notice of site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee, Erika de Pierola.
NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Angela Luz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
LIC809 (FAS) - (06/04)
Page: 5 of 8