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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416286
Report Date: 10/09/2024
Date Signed: 10/09/2024 03:31:42 PM

Document Has Been Signed on 10/09/2024 03:31 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:NOVOA DUQUE, JOSUEFACILITY NUMBER:
434416286
ADMINISTRATOR/
DIRECTOR:		NOVOA DUQUE, JOSUEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(575) 791-8359
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 9DATE:
10/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Josue Novoa DuqueTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Josue Novoa Duque for a case management visit. LPA explained the nature of the visit. Present were licensee, licensee's assistant Karen Castro, licensee's 10 year old son and nine day care children including three infants. Licensee's second assistant Tatihana Gomez arrived during visit.

A review of staff records on 10/08/2024 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 Josue Novoa Duque 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 a working smoke and carbon monoxide detector. LPA observed one infant less than one year sleeping on their tummy. LPA did not observed an Individual Infant Sleep Plan (LIC9227) completed in infant's file. LPA observed one infant sleeping on a mat. LPA asked if child was able to climb out of play pen. Licensee's assistant stated no. Assistant Karen Castro was present in room while children napped.



LPA discussed the safe sleep regulations with licensee Josue Novoa Duque 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 Josue Novoa Duque 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: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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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Document Has Been Signed on 10/09/2024 03:31 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 10/09/2024 at 03:01 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: NOVOA DUQUE, JOSUE
FACILITY NUMBER: 434416286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2024
Section Cited
CCR
102425(a)

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There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.
This requirement was not met as evidenced by LPA observed one infant sleeping on a mat. LPA asked if child was able to climb out of play pen. Licensee's assistant stated no.
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LPA informed licensee that all infants must sleep in play yards unless they are able to get out on their own. Licensee will submit a statement stating he and his assistants have read safe sleep regulations.
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This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
10/16/2024
Section Cited
CCR102425(d)

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The provider shall place infants up to 12 month of age on their backs for sleeping. This requirement was not met as evidenced by LPA observed one infant less than one year sleeping on their tummy. LPA did not observed an Individual Infant Sleep Plan (LIC9227) completed in infant's file.
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LPA informed licensee that all infants under 12 months must sleep on their backs unless a Infant Sleep Plan (LIC9227) is completed and states infant can roll over or exempt by a medical examiner. Licensee will submit a statement stating he and his assistants have read safe sleep regulations.
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This poses a potential risk Health, Safety Personal Rights risk to 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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2024


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: NOVOA DUQUE, JOSUE
FACILITY NUMBER: 434416286
VISIT DATE: 10/09/2024
NARRATIVE
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The following type B deficiencies were cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
LIC809 (FAS) - (06/04)
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