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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416205
Report Date: 02/15/2023
Date Signed: 02/15/2023 03:30:30 PM

Document Has Been Signed on 02/15/2023 03:30 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:SUTACHAN, JEIMYFACILITY NUMBER:
434416205
ADMINISTRATOR:JEIMY SUTACHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 309-2128
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
02/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Jeimy SutachanTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Teodoro Trujillo conducted a site visit to deliver complaint findings and to conduct a CASE MANAGEMENT visit. LPA was greeted by Licensee Jeimy Sutachan, present were licensee's two assistants, Sonia and Sandra. Sonia was associated to licensee Family Child Care Home on 2/10/2023. There were nine children present (two under the age of two years of age) and seven preschool aged children.

LPA learned that assistant Sonia Santiago was not associated to licensee Jeimy facility. According to Jeimy, Sonia assisted at her Family Child Care Home(FCCH) on November 28, 2022.
LPA reviewed supporting documentation dated on November 28, 2022, that showed licensee Jeimy Sutachan did not associate Sonia to her FCCH. Sonia is an assistant to Jeimy adult sister Lida who has a licensed child care home, and Sonia has all the required documentation in that facility.

California Code of Regulations, (Title 22, Division 12 & Chapter 1), is being cited on the attached LIC 809D.

Copy of appeal rights provided to the Licensee. Exit interview conducted in Spanish and report was reviewed with the licensee Jeimy Sutachan.

LPA Teodoro Trujillo informed licensee Jeimy Sutachan that this report dated 2/15/2023 document(s) one (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 Teodoro Trujillo informed the licensee Jeimy Sutachan to provide a copy of this licensing report dated 2/15/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next 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.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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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Document Has Been Signed on 02/15/2023 03:30 PM - It Cannot Be Edited


Created By: Teodoro Trujillo On 02/15/2023 at 02:40 PM
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: SUTACHAN, JEIMY
FACILITY NUMBER: 434416205

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/16/2023
Section Cited
CCR
102370(d)(2)

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 102370(j)
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Licensee has submitted supporting documentation to LPA to support the transfer assistant Sonia to the facility during this visit. Staff Sonia is now associated to the facility. Civil Penalties assessed at today's visit in the amount of $100.00
($100.00x 1 days)
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This requirement was not met as evidenced by: Based on observation and licensee interview, Licensee stated Sonia, assisted her on 11/28/2022 before being cleared or associated to her child care home in GUARDIAN. Licensee confirms she allowed Sonia to work on 11/28/2022, which poses an immediate risk to the Health, Safety or Personal Rights to the children in care.
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AB633 Parent Notification is required. This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.

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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:Mary Segura
LICENSING EVALUATOR NAME:Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023


LIC809 (FAS) - (06/04)
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