434413549-5-9-2025-07-CC-SYUU-DGHMGX-20250509093640

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413549
Report Date: 05/06/2025
Date Signed: 05/09/2025 09:36:52 AM

Document Has Been Signed on 05/09/2025 09:36 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	LARA, ANITA		FACILITY NUMBER:	434413549
ADMINISTRATOR/ DIRECTOR:	LARA, ANITA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 334-1138
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 4	DATE:	05/06/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:37 AM
MET WITH:	Anita Lara		TIME VISIT/ INSPECTION COMPLETED:	11:55 AM

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Licensing Program Analyst (LPA), Shine Yu, conducted an unannounced Annual Inspection 08:37 am and was greeted and met with the Licensee, Anita Lara.

LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC610), Parents' Rights (PUB 393) and Earthquake Preparedness Checklist (LIC9148). Facility's operating days and hours are Monday to Friday 7:00 AM to 5:30 PM. LPA observed a current Children's roster. The last fire drill was conducted on 01/7/2025. Present are licensee, 1 helper(licensee's daughter) and 4 children, including 1 under 2 years old.

LPA reviewed a random selection of 4 children's files and observed that notification of parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification forms are in each file.

LPA also reviewed the staff files for the following records: Employee Rights (LIC9052), Statement Acknowledging Requirement to report Child Abuse (LIC9108), and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza. Licensee's pediatric 1st Aid and CPR certificate, expires December 2025. Licensee and helper's mandated reporter training certificate expired on January, 2025. Licensee stated will take the course immediately and will provide a copy of certificate to LPA when it's completed.

Licensee accompanied with LPA to tour the facility. Off limits areas inside the home are master bedroom, 2 bed rooms and garage. LPA observed the fire extinguisher in the kitchen, the smoke and carbon monoxide detector are in living room and hall way (LPA test both detectors). LPA provided a copy of Healthy Beverages in Child Care flyer(AB2084) to the licensee. The bathroom is clean and organized. There are age-appropriate toys in the living room and play yard for children. Licensee stated there is no firearm in the facility. There is no stairs in the facility. There is no body of water observed outside of play yard.The outdoor play area is enclosed with appropriate fence and safe for children.

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Gladys Kuizon	TELEPHONE: (510) 566-5850
Syhshyan Yu	TELEPHONE: (408) 334-8321
	DATE: 01/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LARA, ANITA	FACILITY NUMBER: 434413549
	VISIT DATE: 05/06/2025

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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 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.

Licensee stated there is no medication provided in the facility. 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/.

LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

The 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.

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SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Syhshyan Yu	TELEPHONE: (408) 334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LARA, ANITA	FACILITY NUMBER: 434413549
	VISIT DATE: 05/06/2025

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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.

Exit interview conducted and report was reviewed with the licensee, Anita Lara.

The licensee also confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

1 type B citation was issued during today’s inspection and a copy of appeal right was provided to the licensee.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Syhshyan Yu	TELEPHONE: (408) 334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/09/2025 09:36 AM - It Cannot Be Edited

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: LARA, ANITA	FACILITY NUMBER: 434413549
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 record review, the licensee and her staff botn did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/16/2025
	Plan of Correction
1 2 3 4	Licensee will enroll the mandated reporter training course and provide a copy of certificate before POC due date.

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.

Gladys Kuizon	TELEPHONE: (510) 566-5850
Syhshyan Yu	TELEPHONE: (408) 334-8321
	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

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