434416045-2-4-2022-07-CC-SCES-CBBT85-20220204132946

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416045
Report Date: 02/04/2022
Date Signed: 02/04/2022 01:29:55 PM

Document Has Been Signed on 02/04/2022 01:29 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:	RUIZ TORRES, EVELYN		FACILITY NUMBER:	434416045
ADMINISTRATOR:	EVELYN RUIZ TORRES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 716-7318
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	02/04/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Evelyn Ruiz Torres		TIME COMPLETED:	01:45 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	On 02/04/2022 at 11:00 AM, Licensing Program Analyst (LPA) Susy Cervantes conducted an announced pre-licensing visit to the home. LPA met with Evelyn Ruiz Torres, Applicant, and explained the nature of today's visit to her. The adults that reside in the home are the Applicant, their spouse and brother in law. Days and hours of operation will be Monday - Friday from 7:30 AM to 5:30 PM. Applicant has completed her Preventative Health and Safety Child Care Training on 07/11/2021 and a copy of completion is on file. Applicant's CPR and First Aid certifications are current and expire on 05/11/2023. Mandated Reporter Training was completed on 05/17/2021. Applicant rents the home. Applicant plans to get liability insurance, LPA informed applicant while they do not have insurance, they must issue affidavit regarding liability insurance for FCCH to parents. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 02/04/2022 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. Applicant 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 toured the indoor and outdoor areas during today's visit. LPA observed no stairs, no wall heater and a covered fireplace in the home. Off limit areas inside the home: garage, one bedroom, master bedroom, master bathroom, and kitchen *Continues on report dated 02/04/2022 pg. 1/3*

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022

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: RUIZ TORRES, EVELYN	FACILITY NUMBER: 434416045
	VISIT DATE: 02/04/2022

NARRATIVE

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Continuation of report dated 02/04/2022 pg. 2/3

LPA observed a new 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, a fenced backyard, and no bodies of water. Off limit areas outside the home: Right side of back yard that is fenced off. Applicant states that there are no weapons in the home. Applicant stated they have a cat and dog that are staying with their in laws, but may be bringing to the facility. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children and stored in the garage and top kitchen cabinet. LPA reminded Applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes.

Forms of discipline used by Applicant: talk to children. Applicant understands that children's personal rights should not be violated; including no corporal punishment. A Family Child Care Home packet with updated Licensing forms was provided to and reviewed with the Applicant. Department website: www.ccld.ca.gov. provided to Applicant. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting unusual incidents/injuries, suspected child abuse (Mandated Reporter training AB 1207), SB 792 (Immunization's for Measles Pertussis and Influenza) and healthy beverages in child care, 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.

Incident 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) 415-0301 (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.

LPA discussed the safe sleep regulations with applicant 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 licensee [facility representative] 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.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022

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: RUIZ TORRES, EVELYN	FACILITY NUMBER: 434416045
	VISIT DATE: 02/04/2022

NARRATIVE

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Continuation of report dated 02/04/2022 pg. 3/3

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

Exit interview conducted and report was reviewed with the licensee Evelyn Ruiz Torres. LPA advised applicant that Licensure for a large family child care home is granted pending the following:

-Fingerprint transfer for applicant

- Management's approval.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022

LIC809 (FAS) - (06/04)

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