<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415486
Report Date: 10/09/2024
Date Signed: 10/09/2024 12:39:13 PM

Document Has Been Signed on 10/09/2024 12:39 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:CETINA DE NOVOA, CORINAFACILITY NUMBER:
434415486
ADMINISTRATOR/
DIRECTOR:		CETINA DE NOVOA, CORINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 208-5693
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
10/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Corina Cetina De NovoaTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Corina Cetina De Novoa for a case management visit. LPA explained the nature of the visit. Present were licensee, licensee's two assistants and 10 day care children including four infants.

A review of staff records on 10/08/2024 indicates that not all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee's renter, Kendrew Nathanael Taniara is not associated to the facility.

LPA reviewed 10 children's files. Child 8 is missing LIC627. LPA observed a working smoke and carbon monoxide detector. LPA observed shampoo and Comet cleaning spray in a bathroom cabinet accessible to children. LPA observed day care carpets are dirty and stained.

The following type A and B deficiencies were cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

LPA Deanna Villagrana informed licensee Corina Cetina De Novoa that this report dated 10/09/2024 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deanna Villagrana informed the licensee Corina Cetina De Novoa to provide a copy of this licensing report dated 10/09/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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 5
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: CETINA DE NOVOA, CORINA
FACILITY NUMBER: 434415486
VISIT DATE: 10/09/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 10/09/2024 12:39 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 10/09/2024 at 11:11 AM
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: CETINA DE NOVOA, CORINA
FACILITY NUMBER: 434415486

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/10/2024
Section Cited
CCR
102370(d)(1)

1
2
3
4
5
6
7
Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by Licensee's renter, Kendrew Nathanael Taniara is not associated to the facility.
1
2
3
4
5
6
7
Licensee will ensure Kendrew Nathanael Taniara is cleared before returning to the home.
8
9
10
11
12
13
14
This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2024


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/09/2024 12:39 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 10/09/2024 at 11:23 AM
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: CETINA DE NOVOA, CORINA
FACILITY NUMBER: 434415486

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/09/2024
Section Cited
CCR
102417(g)(7)

1
2
3
4
5
6
7
An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
1
2
3
4
5
6
7
Licensee requested from parent during visit. Deficiency cleared today.
8
9
10
11
12
13
14
This requirement was not met as evidenced by Child 8 is missing LIC627. This poses a potential risk Health, Safety Personal Rights risk to children in care.
8
9
10
11
12
13
14
Type B
10/09/2024
Section Cited
CCR102417(g)(4)

1
2
3
4
5
6
7
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
1
2
3
4
5
6
7
Licensee removed during visit and made them inaccessible to children. Deficiency cleared today.
8
9
10
11
12
13
14
This requirement was not met as evidenced by LPA observed shampoo and Comet cleaning spray in a bathroom cabinet accessible to children. This poses a potential risk Health, Safety Personal Rights risk to children in care.
8
9
10
11
12
13
14
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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 10/09/2024 12:39 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 10/09/2024 at 11:30 AM
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: CETINA DE NOVOA, CORINA
FACILITY NUMBER: 434415486

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2024
Section Cited
CCR
102417(g)(2)

1
2
3
4
5
6
7
The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This requirement was not met as evidenced by LPA observed day care carpets are dirty and stained.
1
2
3
4
5
6
7
Licensee will clean the carpets and replace if need be. Photos of cleaned carpets are to be submitted to CCLD by POC date.
8
9
10
11
12
13
14
This poses a potential risk Health, Safety Personal Rights risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2024


LIC809 (FAS) - (06/04)
Page: 5 of 5