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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416285
Report Date: 11/14/2024
Date Signed: 11/19/2024 08:35:04 AM

Document Has Been Signed on 11/19/2024 08:35 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LANDAVERDE, IVETTFACILITY NUMBER:
434416285
ADMINISTRATOR/
DIRECTOR:		LANDAVERDE, IVETTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 392-5006
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 7DATE:
11/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:58 AM
MET WITH:Ivett LandaverdeTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Licensing Program Analysts (LPAs) Mandeep Kaur and Syhshyan "Shine" Yu, conducted an unannounced Annual/Random inspection. LPAs met with Licensee, Ivett Landaverde and explained the reason for the inspection. Present during today's inspection were Licensee, seven children, three were infant ages, and an adult assistant.

The hours of operation are Monday through Friday 7AM to 6PM. There is a board to post required postings,
such as license and notification of parent's rights.

LPAs toured the inside and outside of the home with Licensee. The off-limits areas inside are Masterbedroom, kitchen and office. Disinfectant and cleaning supplies were inaccessible to children. LPAs reminded Licensee that anything sharp or states to keep out of reach of children, such as blades or razors need to be inaccessible.

There are toys and equipment for children. The home has adequate lighting and ventilation. There is a fully charged fire extinguisher, was bought on 06/27/24, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 06/14/2024. Licensee stated that there are no weapons, such as firearm, stored in the home.

The backyard is accessible for the children to play and fenced. Playarea has age appropriate toys and equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-
CCP. 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/resources/child-care-centers/.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LANDAVERDE, IVETT
FACILITY NUMBER: 434416285
VISIT DATE: 11/14/2024
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Healthy Beverages requirements were discussed and copy is provided.

A copy of the facility roster was obtained. Five (5) children's files were reviewed during today's inspection. The records reviewed include but not limited to immunization records and notification of parent's rights. LPAs also reviewed sleep log and the LIC 9227.

One assistant file was reviewed during today's inspection. Reviewed records are immunizations, mandated reporter training certification, and CPR & First Aids training for an assistant are valid.

Licensee completed the Mandated Reporter training on 12/22/2022. Licensee has a valid CPR/1st Aid, which
expires on 08/2025.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The adults 18 and over living in the home are Licensee and her two adult children. All adults have cleared
criminal record and child abuse index. Licensee was reminded that all adults 18 and over living or working in
the home, including employees and volunteers, except as specified in Health and Safety Code section
1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

During the exit interview, the Licensee, Ivett Landaverde, confirmed that there are no Registered Sex Offenders living in the facility and LPA, Kaur completed the RSO profile in FAS.

No deficiency issued during today's inspection.

Exit interview conducted and report was reviewed with Licensee. Ivett Landaverde.
A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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