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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416044
Report Date: 05/24/2023
Date Signed: 06/16/2023 08:33:37 AM

Document Has Been Signed on 06/16/2023 08:33 AM - 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: 4DATE:
05/24/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Brenda Bernal TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen conducted an unannounced case management inspection to the home today. Licensee requested to increase her licensed capacity to 14 children. Licensee has been licensed as a small Family Child Care Home since April 19, 2022 at the same location and is eligible to apply for the capacity increase. LPA met with Licensee, Brenda Bernal and explained the nature of today's visit to her. LPA also observed 4 day-care children; preschoolers. Days and hours of operation are Monday - Friday from 5:30 AM to 4:00 AM. The adults that reside in the home are the Licensee, her husband (Miguel Gomez) adult son (Brandon Gomez) and her 13 year old daughter.
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, where washer and dryers are kept. There is a latch on top of the accordion closet door. Licensee uses the front fenced area for outdoor play space. Licensee has a pet dog and kitten in the home.
A review of staff records on 05/24/23 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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 observed Licensee has current CPR and First Aid certifications which expire on 07/26/24. LPA observed a current roster of the children and a fire and disaster drills log. The last drills were conducted on March 17,2023. LPA reviewed 4 children files and files were complete.
Mandated Reporter Training was completed on 08/12/2022. Licensee has copies of immunization records on file for measles, pertussis and influenza. The facility carries liability insurance under Acord.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
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: BERNAL, BRENDA
FACILITY NUMBER: 434416044
VISIT DATE: 05/24/2023
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Supervision of children was discussed with Licensee, and she understands that she must be present in the home during day care hours and ensure that the children are always supervised. Licensee understands her capacity options. Licensee states that she does not transport children via vehicle, but she understands that children cannot be left in parked vehicles unattended at any time.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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.

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: https://www.ada.gov/childqanda.htm
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
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: BERNAL, BRENDA
FACILITY NUMBER: 434416044
VISIT DATE: 05/24/2023
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To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Based on today's inspection, A large Family Child Care Home license will be approved once fire inspection approval (850) is received. LPA notes that the fire marshal approved the home on 05/20/23.

No deficiency was cited. A notice of site visit was given and must remain posted for 30 days. The report was discussed and verbally translated into Spanish today.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC809 (FAS) - (06/04)
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