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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412224
Report Date: 07/05/2023
Date Signed: 07/05/2023 02:55:20 PM

Document Has Been Signed on 07/05/2023 02:55 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 DEL CARMENFACILITY NUMBER:
434412224
ADMINISTRATOR:DELGADO, MARIA DEL CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 603-8341
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/05/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Maria Del Carmen DelgadoTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Teodoro Trujillo and Licensing Program Manager (LPM) Mary Segura conducted a scheduled Informal Office meeting at the San Jose Regional Office with Licensee Maria Del Carmen Delgado and her Uncle Jesu s to discuss issues and citations issued on 06/20/2023.

On 06/20/2023, LPA Trujillo arrived 09:10 AM for an annual inspection and observed licensee was over capacity, with 11 children: eight (8) infants and three (3) preschool age, one preschool age child is licensee daughter. Assistant Natalia was also present but did not have criminal record clearance/transfer completed.

LPA observed a roster of the children that had not been updated. LPA observed infant 15-minute Infant sleep logs missing for the eight infants in care, and Child 3 (c3), c4, c5, and c7 were missing Infant individual sleeping plan (LIC 9227).

LPA observed a 3A40BC fire extinguisher, licensee stated she last purchased in 2020 and has not been serviced. LPA observed bathroom sink cabinet had soap and toilet cleaning supplies, and kitchen sink cabinet had a bottle of Mr. Clean cleaner accessible to children in care. LPA observed assistant Natalia was missing proof of pertussis vaccine, and licensee stated Mandated Reporter Training has not been renewed for herself and assistant Maria Luisa.

LPM Mary Segura, explained that if there are continued serious deficiencies cited against the facility including but not limited to citations for staying in ratio and capacity and hazardous items accessible to children, complying with safe sleep requirements, the licensee may be referred to legal for possible administrative action, which could include revocation of the facility license. The facility will be monitored more frequently to ensure that the facility is maintaining compliance with Title 22 regulations. Licensee Maria Del Carmen Delgado was provided a copy of the regulations regarding Staffing Ratio and Capacity, Safe Sleep regulations and maintaining safety equipment including but not limited to fire extinguishers. LPA received Plan of Corrections on 7/5/23, still under review.
LPM Mary Segura discussed the requirement of AB 633 in English and Spanish with Licensee Maria Del Carmen Delgado and provided her with the AB 633 fact sheet in English and Spanish and a copy of Acknowledgment of Receipt of Licensing Reports (LIC 9224) and understands the requirements.

Copies of this report dated 07/05/2023 must be provided to Parents/Guardians of children currently in care at this Facility and to the Parents/Guardians of newly enrolled children at the Facility for the next 12 months
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/05/2023
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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