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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415485
Report Date: 07/15/2021
Date Signed: 07/15/2021 05:25:31 PM

Document Has Been Signed on 07/15/2021 05:25 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:QUIROZ, MAGALLYFACILITY NUMBER:
434415485
ADMINISTRATOR:QUIROZ, MAGALLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 703-3277
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
07/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Magally QuirozTIME COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Manager (LPM) Diana Stephenson and Licensing Program Analyst (LPA) Ofelia Calivo conducted an unannounced Required 1 Year inspection at 2:00 PM. LPM and LPA met with Licensee Magally Quiroz and explained the purpose of today’s inspection. The adults residing in the home are the Licensee, Licensee’s husband, Licensee’s father and mother, and Licensee’s minor daughter. All the adults living in the home have fingerprint clearances. LPM and LPA observed seven children during today’s inspection. Days and hours of operation are Monday through Friday from 7:00 AM to 6:00 PM.

The Licensee has a working telephone and the phone number is (650) 703-3277. LPM and LPA observed the Facility License, Emergency Disaster Plan, Earthquake Preparedness Checklist, and Notification of Parents’ Rights Poster posted on the board. Licensee’s First Aid and CPR card is current and will expire on March 28, 2023.

LPM and LPA reviewed the Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on June 25, 2021. The Licensee has the required immunizations (MMR, Tdap, & Flu) and Licensee’s Mandated Reporter Training is expired on 02/18/2019. LPM and LPA reviewed children's files and observed current and updated Identification and Emergency Information (LIC 700) and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. The Licensee states that when a child shows sign of illness, the child will be isolated in the living room while waiting to be picked up by parents.
LPA discussed the new “Safe Sleep” regulations with the Licensee and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensee.
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SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Ofelia Calivo
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: QUIROZ, MAGALLY
FACILITY NUMBER: 434415485
VISIT DATE: 07/15/2021
NARRATIVE
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----------------------------Continuation from 809------------------------------------------------------------
LPA reminded the Licensee that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA observed a screened fireplace and there are no stairs in the home. LPM and LPA observed the home with centralized heating and ventilation for the safety and comfort of the children in care. Off limit areas inside the home: master bedroom, master bathroom, one bedroom, furnace closet, and attached garage.

LPM and LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors. LPM and LPA observed that there are no bodies of water, and the backyard is fenced. LPM and LPA observed one dog and it is vaccinated. Licensee confirmed there are no weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Any poisons are locked and inaccessible to the day care children. The Licensee states that she does administer medication to one day care child and must provide a Plan of Operation.

A review of staff records today, indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded the Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children.

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SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Ofelia Calivo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: QUIROZ, MAGALLY
FACILITY NUMBER: 434415485
VISIT DATE: 07/15/2021
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Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time without a fully qualified assistant. The Licensee states that does not transport any day care children. The Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

During today's inspection, Type B deficiencies are cited on the 809-D page.
LPA conducted an exit interview with the Licensee.

Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Ofelia Calivo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/15/2021 05:25 PM - It Cannot Be Edited


Created By: Ofelia Calivo On 07/15/2021 at 03:39 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: QUIROZ, MAGALLY
FACILITY NUMBER: 434415485

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2021
Section Cited
HSC
1596.8662(b)(1)

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided
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BY POC DUE DATE: 08/15/2021. Licensee agreed to renew her Mandated Reporter training certificated at the POC date and will send a copy of certificate to LPA via email.
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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 was not met and poses a potential ristk to the health, safety, and personal rights of children in care.
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Type B
07/15/2021
Section Cited
CCR102418(g)(1)

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The licensee shall document each child's immunizations as required by the California Code of Regulations and shall maintain such documentation for as long as the child is enrolled.

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BY POC DATE: 07/25/2021. Licensee will email LPA proof of immunization by the POC due date.
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(1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home. This requirement was not met and poses a potential ristk to the health, safety, and personal rights of children in care. C1 did not have immuninization record on file.
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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:Diana Stephenson
LICENSING EVALUATOR NAME:Ofelia Calivo
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2021


LIC809 (FAS) - (06/04)
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