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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414150
Report Date: 05/05/2023
Date Signed: 05/05/2023 12:21:44 PM

Document Has Been Signed on 05/05/2023 12:21 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:MORAN, PATRICIAFACILITY NUMBER:
434414150
ADMINISTRATOR:MORAN, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 687-8635
CITY:SAN JOSESTATE: CAZIP CODE:
95110
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
05/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Gudalupe Rodriguez
TIME COMPLETED:
12:30 PM
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On 05/05/2023 at 9:06 AM, Licensing Program Analyst (LPA) Teodoro Trujillo met with assistant Guadalupe, for an annual inspection and explained the reason for the visit to her. Upon arrival assistants Guadalupe and Carolina were present during today's visit with 7 children: two (2) infants and five (5) preschool age, licensee Patricia, two (2) infants and two (2) preschool age children arrived during site inspection. Adults living in the home are licensee, and her spouse. Days and hours of operation are Monday through Friday 06:00 AM to 06:00 PM.

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 4/24/2023 was reviewed and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA inspected inside and outside of single-story home. LPA observed no fireplace, no wall heater, no stairs, and no bodies of water. Licensee stated there are no weapons. LPA observed pets. LPA observed a 3A40BC fire extinguisher last serviced on 04/21/2023. Carbon Monoxide and smoke detectors are operable. Sharp objects, medicines, poisons, and cleaning supplies were inaccessible to children in care. Off limit areas inside the home: Bedroom and gated kitchen area. On limit areas: Music room, Activity room, kitchen, bathroom and living room.

Backyard is fenced. LPA observed a basement that has an entry from the indoor music room and another one from the backyard. Both entries to the basement are blocked/locked inaccessible to children. LPA observed the basement consists of two storage room and a bedroom. Off limits outdoor: the fenced off car port and basement. On limit areas outside the home: rear back yard playground area

Children were supervised during the visit and LPA went over substitute options and reminded licensee they could only have 14 children according to her license. Licensee stated she does transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.

Continues report dated 05/05/2023 pg.1/2

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2023
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 2
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: MORAN, PATRICIA
FACILITY NUMBER: 434414150
VISIT DATE: 05/05/2023
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Continuation of report dated 05/05/2023 pg. 2/2

LPA observed a current roster of the children. LPA observed a fire and disaster drill log last performed on 02/05/2023. LPA reviewed 6 children’s files and observed all required documentation was in compliance. Infant individual sleeping plan (LIC 9227) for each infant under 12 months was discussed and a 15-minute check sleep log for infants under 24 months was provided. LPA observed licensee and assistant Guadalupe completed Mandated Reporter Training on 01/21/2022, assistant Carolina completed on 07/21/2022. Licensee and both assistants have Pediatric CPR/1st Aid expiring on 03/04/2023. Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is current for licensee, and all adults residing in the home.

Incidental Medical Services (IMS) policy was discussed with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing IMS currently. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

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-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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

No deficiencies were cited during today's visit. Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.


Exit interview conducted and report was reviewed in Spanish with the licensee, Patricia Moran. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
LIC809 (FAS) - (06/04)
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