434416004-7-6-2021-07-CC-JTSE-C4H2XF-20210630174704

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416004
Report Date: 06/30/2021
Date Signed: 07/06/2021 12:51:46 PM

Document Has Been Signed on 07/06/2021 12:51 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:	CASILLAS, MARIAN & SANDOVAL, JUAN		FACILITY NUMBER:	434416004
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	06/30/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Marian Casillas & Juan Sandoval		TIME COMPLETED:	06:00 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) Janet Tse conducted an announced pre-licensing inspection to the home today. LPA met with Marian Casillas and Juan Sandoval, applicants, and explained the nature of today's visit to them. The inspection was conducted in Spanish. LPA also observed a tenant (IK) in the home during today's visit. The adults that reside in the home are the applicants and a tenant with three children ages 12, 9 1/2, and 7 1/2. Days and hours of operation will be Monday to Friday from 7:00 am to 6:00 pm. Applicants have completed their Preventative Health and Safety Training on 03/08/2021 and a copy of the certifications verifying completion is in file. Applicants' CPR and First Aid certifications are current and will expire in March 2023. Applicants rent the home and the Owner/Landlord Notification form (LIC 9151) is in file. LPA reminded the applicants that they cannot care for more than six children unless they obtain the Owner/Landlord consent. Applicants do not have liability insurance and will issue affidavit regarding liability insurance for FCCH. LPA toured the indoor and outdoor areas during today's visit. There are no stairs in the home. The fireplace is blocked. LPA observed the garage is not converted and is for family use only. Off limit areas indoor: All four bedrooms, master bathroom, the barricaded kitchen, and the garage. LPA observed a fully charged 3A40BC fire Facility Evaluation Report dated 06/30/2021 to be continued on next page: (This is an amended report delivered and signed on 07/06/2021) - Pg 1 of 4 -

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Janet Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021

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 4

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: CASILLAS, MARIAN & SANDOVAL, JUAN	FACILITY NUMBER: 434416004
	VISIT DATE: 06/30/2021

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

Facility Evaluation Report dated 06/30/2021 to be continued from previous page:
extinguisher, working smoke and carbon monoxide detectors. LPA observed a fenced backyard, and no bodies of water. Off limit areas outdoor: fenced off patio 3 (per facility sketch). LPA observed a dog in the patio 3. Licensee showed LPA the dog's vaccination record which is current. Applicants stated there are no weapons in the home. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. LPA reminded applicants that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes.

A listing of staff criminal record clearances associated to this facility in the Guardian on 06/25/2021 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. LPA reminded applicants 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. 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.

Applicants understand that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting
Facility Evaluation Report dated 06/30/2021 to be continued on next page: - Pg 2 of 4 -

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Janet Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: CASILLAS, MARIAN & SANDOVAL, JUAN	FACILITY NUMBER: 434416004
	VISIT DATE: 06/30/2021

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

Facility Evaluation Report dated 06/30/2021 to be continued from previous page:
suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

A Family Child Care Home packet with updated Licensing forms was provided to and reviewed with the applicants. Department website: www. ccld.ca.gov provided to Applicant. Website for provider resources: https://cdss.ca.gov/inforesources/Child-Care-Licensing. Periodic information releases accessible by signing up at: www.myccl.ca.gov.

LPA discussed the requirements of AB 633 with the applicants and provided them the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and the applicants understands the requirements. LPA also discussed "zero tolerance" related regulations with the applicants and advised them of the assessment of an immediate $500 civil penalty, and an ongoing $100 per day per violation continues until the violation(s) is corrected.

AB792 Immunization Requirements was discussed. LPA observed the required immunization records for applicants and the tenant were in file.

Effect of Lead Exposure handout dated 1/20/19 given during today’s inspection.
Facility Evaluation Report dated 06/30/2021 to be continued on next page: - Pg 3 of 4 -

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Janet Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4

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: CASILLAS, MARIAN & SANDOVAL, JUAN	FACILITY NUMBER: 434416004
	VISIT DATE: 06/30/2021

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

Facility Evaluation Report dated 06/30/2021 to be continued from previous page:
Applicants understand that per Assembly Bill (AB 2370), written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians. LPA reviewed infants safe sleep policies with the applicants and provided "A Child Care Provider's Guide to Safe Sleep.” More information can be found at https://cdss.ca.gov/inforesources/Child-Care-Licensing. Title 22 regulations regarding safe sleep policies were also discussed.

The Mandated Reporter AB1207 Compliant Child Care Training was also discussed. Website to complete training: https://mandatedreporterca.com. A link to the alternate trainers approved to provide mandated reporter training:
https://www.cdss.ca.gov/Portals/9/CCLD/CCP%20Documents/Approved%20Mandated%20Reporter%20Trainings.pdf. Both applicants have completed the training on 05/18/2021 and certifications are in file. Applicants understand that the training is to be repeated every two years.

Information on COVID-19 ordinances from the health department was discussed and provided to the applicants.

LPA conducted an exit interview with the applicants and advised them that a small Family Child Care Home license is approved effective today, 06/30/2021.
- Pg 4 of 4 -

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Janet Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4