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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415413
Report Date: 11/12/2024
Date Signed: 11/12/2024 04:01:58 PM

Document Has Been Signed on 11/12/2024 04:01 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:FURTADO, ANAFACILITY NUMBER:
434415413
ADMINISTRATOR/
DIRECTOR:		ANA FURTADOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 826-2179
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
11/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Ana FurtadoTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA), Jennifer “Jen” Beehler, met with Licensee, Ana Furtado for an unannounced Required- 1 Year Inspection. LPA was granted access to the day care which was housed in the backside of the garage, by the Licensee and toured both indoors and outdoors during the inspection. Upon arrival, there were 9 children preschool aged and 2 staff present, which is compliant with the home license capacity and ratio requirements. LPA observed did not observe required postings near the entrance to the daycare. Hours of operation for the facility are Monday – Friday, 07:30AM-05:30PM. There are no active waivers or exceptions.

Licensee states that adults, over the age of 18, residing in the home are: herself and her spouse (Bret Furtado). All adults residing in the home have Criminal Background Check Clearance and signed Criminal Record Statements (LIC508). 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 reviewed facility roster (LIC9040) and fire/disaster drill log during today's inspection. The last fire/disaster drill was conducted on 09/05/2024, which is compliant with the six month requirement for homes. LPA observed a 2A10BC fire extinguisher that was manufactured in 2022. LPA reviewed Fire Marshall requirements which states a fire extinguisher needs to be purchased annually or serviced annually. There was a functioning combination smoke detector and carbon monoxide detector. Licensee states that she does not currently have any children in care who require Incidental Medical Services.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: FURTADO, ANA
FACILITY NUMBER: 434415413
VISIT DATE: 11/12/2024
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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/.

The Licensee states that there are no weapons or firearms in the home.

Indoor areas of the home were not inspected by the LPA today as licensee stated the day care was now in the large room attached to the backside of the garage. Licensee stated this room has been attached to the garage since before her husband moved in when he was a child. It used to be her father-in-law's workshop and had not been used for 20 years since his death. Last year they cleared it out and put carpet down and moved day care to this room. The room was observed to be clean, orderly, and safe for the day care children. Off-limit areas of the day care include: front section of back yard, driveway, front yard, garage and main house. LPA observed sufficient age-appropriate materials, toys, and play equipment in the day care room. A corner of the area was sectioned off for portable potties for toddler aged children and a diaper changing table for children in diapers. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. Licensee provides an AM/PM vegetarian snack daily, lunch is provided from home. Drinking water is readily available for children in the facility via water dispensers and reusable water bottles. Licensee stated some have children's names on it, but all the children know which bottle are theirs. LPA reminded licensee that all personal bottles or lunch boxes need to be labeled with child's name. Currently Licensee doesn't have school aged children in care, but if she did they would use the bathroom inside the garage, which is accessed through the front end of the structure. LPA observed the bathroom to be clean, sanitary, and operable. The Licensee has a working telephone in the facility, she uses her cell phone.

The backyard area of the home was inspected. LPA observed sufficient play equipment and supplies for the children that are in good condition and age-appropriate. No outdoor bodies of water were observed during today's inspection. LPA observed a corner of the play area where garden tools that are sharp and partially rusted were accessible to children in care.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
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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: FURTADO, ANA
FACILITY NUMBER: 434415413
VISIT DATE: 11/12/2024
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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.

4 children’s files were reviewed during today's inspection and all required documents were present, including: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Immunization Records but not transferred to the PM286.

1 staff file (helper) were reviewed and all required documents were present, including: Employee Rights (LIC9052), Criminal Record Statement (LIC508), Statement Acknowledging Requirement to report Child Abuse (LIC9108), Mandated Reporter Training Certificate, and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza declination. There is at least one staff member present with current CPR/First-Aid that expires 06/17/2025. The Licensee has current Mandated Reporter Training that expires on 07/06/2025 and LPA reminded that training must be renewed by all staff every 2 years.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The Licensee states that she does not transport any day care children. LPA reminded Licensee that children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

As a result of today's inspection, one Type B deficiency was issued. More information can be found on the attached LIC809-D.

Exit interview conducted with licensee, Ana Furtado. Report reviewed and provided to licensee along with appeals rights. NOTICE OF SITE VISIT PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/12/2024 04:01 PM - It Cannot Be Edited


Created By: Jennifer Beehler On 11/12/2024 at 03:26 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: FURTADO, ANA
FACILITY NUMBER: 434415413

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in the backyard play area where gardening tools with pointed edges accessible to children which poses a potential health, safety risk to persons in care.
POC Due Date: 11/27/2024
Plan of Correction
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Licensee will remove tools to an area inaccessible to children in care.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:
DATE: 11/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/12/2024


LIC809 (FAS) - (06/04)
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