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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416044
Report Date: 12/09/2022
Date Signed: 12/14/2022 04:11:47 PM

Document Has Been Signed on 12/14/2022 04:11 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:BERNAL, BRENDAFACILITY NUMBER:
434416044
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
12/09/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Brenda BernalTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Brenda Bernal for an annual random inspection. LPA was granted access to the home by the Licensee.
LPA also observed six pre-school children, adult son, Brandon and minor daughter.

Licensee was operating within the capacity and ratio requirements of her license. LPA observed the required postings, including the facility license, near the main entrance to the home. Days and hours of operation are Monday - Friday from 5:30 AM to 9:00 PM. The Licensee and her spouse (Miguel Angel Gomez) and adult son (Brandon Gomez) are the only adults living in the home. Licensee has a 12 year old daughter who lives in the home.

LPA reviewed a current Child Care Facility Roster and fire disaster drill; last practiced drill was 10/14/2022. Licensee has day care insurance with Acord. Licensee has current CPR and First Aid certifications (expiration: 07/26/2024). Licensee and her adult assistant (Brandon Gomez) have the required vaccines (MMR, Tdap, & flu) and are current with her Mandated Reporter Training for Child Care Workers. LPA reviewed six children files and the files were complete with the required forms and immunization records. LPA reviewed two staff files (Licensee & adult assistant) and the files were complete with the required forms and immunization records.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (646) 474-2508 The home is clean, orderly, (including central heating/air conditioning/ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. There are no open face heaters or fireplace units inside the home. There are no stairs inside the home. The off limit areas inside the home are: 2 bedrooms, garage and bathroom closet. Licensee uses the front fenced area for outdoor playspace.

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water. Licensee states that she does not have any weapons in the home. Licensee has a pet dog. Licensee states she will schedule an appointment to get the dog shots. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Licensee understands that any poisons are to be locked.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2022
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: BERNAL, BRENDA
FACILITY NUMBER: 434416044
VISIT DATE: 12/09/2022
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Licensee states that she provides all meals, including snacks (AM & PM) and lunch to the day care children. Licensee understands that smoking is prohibited in the home.

Licensee states that she does not administer any medications to the day care children at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

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. Licensee understands the capacity/ratio options and she understands that she cannot have more than 8 children present in the home. Licensee states that a child will be isolated in the living room area if necessary due to illness or communicable disease. Licensee states that she currently does not transport any day care children. 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.

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 discussed the safe sleep regulations with the 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 the 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

Exit interview conducted and report was reviewed with the Licensee, Brenda Bernal. No deficiencies issued during today's inspection

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC809 (FAS) - (06/04)
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