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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416214
Report Date: 09/22/2021
Date Signed: 09/22/2021 03:57:23 PM

Document Has Been Signed on 09/22/2021 03:57 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:PEREZ, VONITAFACILITY NUMBER:
434416214
ADMINISTRATOR:VONITA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 230-9274
CITY:SAN JOSESTATE: CAZIP CODE:
95133
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
09/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Vonita Perez, LicenseeTIME COMPLETED:
04:07 PM
NARRATIVE
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#2 Licensing Program Analyst (LPA), James Santos conducted an unannounced Required 1 Year Inspection today. LPA met with Licensee, Vonita Perez. There are six (6) day care children in the home during today's visit.

LPA toured the home with Licensee. The home was observed to be clean and in good order. There are sufficient toys and play equipment for the day care children. Bathroom used by children was observed to be clean and in good condition. Per Licensee, there are no weapons and poisons in the home. The home has fire extinguisher, carbon monoxide and smoke detector. The fireplace is observed to be barricaded. Off limit areas in the home are as follows; All bedrooms, kitchen, living-room and garage.

The backyard area is surrounded and enclosed by a fence. There are no bodies of water observed.

LPA reviewed the roster of children in care. Children's records were reviewed which include Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice and Immunization record.

Licensee's files was reviewed which include fingerprint clearance and CPR/First Aid which expires on January 23, 2023. Licensee's AB1207 Mandated Reporter Training certificate expired on January 5, 2021. LPA discussed with Licensee Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

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SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2021
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: PEREZ, VONITA
FACILITY NUMBER: 434416214
VISIT DATE: 09/22/2021
NARRATIVE
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Per review of the Facility fire/disaster drill log, the last drill was conducted in February 2020. LPA reminded Licensee that each family child care home shall conduct fire drills and disaster drills at least once every six months.

LPA reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensees are encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoptions of new laws, pay annual fees etc.



Incidental Medical Services (IMS) policy was discussed. Licensee stated that she's not planning to provide IMS at this time.

As a result of this inspection, deficiencies were cited. See LIC809D pages for deficiencies.



A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/22/2021 03:57 PM - It Cannot Be Edited


Created By: James G Santos On 09/22/2021 at 03:28 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: PEREZ, VONITA
FACILITY NUMBER: 434416214

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/22/2021
Section Cited
HSC
1596.8662(4)(b)(1)

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Licensee agreed to complete the AB1207 Mandated Reporter Training and will submit proof of completion to Licensing by POC date, 10/22/2021.
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This requirement was not met as evidenced by: Per review of record, Licensee's AB1207 Mandated Reporter Training expired on January 5, 2021. This poses a potential risk to the health and safety of children in care.
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Type B
10/22/2021
Section Cited
CCR102417(g)(9)(A)(1)

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Operation of a Family Child Care Home:
Each family child care home shall conduct fire drills and disaster drills at least once every six months. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
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Licensee agreed to complete the Facility fire/disaster drill and will submit proof of completion to Licensing by POC date, 10/22/2021.
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This requirement was not met as evidenced by: Per review of the Facility fire/disaster drill log, the last drill was conducted in February 2020. This poses a potential risk to the health and safety of children in care.
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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:Anthony Studebaker
LICENSING EVALUATOR NAME:James G Santos
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2021


LIC809 (FAS) - (06/04)
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