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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416317
Report Date: 06/17/2022
Date Signed: 06/17/2022 02:40:15 PM

Document Has Been Signed on 06/17/2022 02:40 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:YAMIN, DELILAHFACILITY NUMBER:
434416317
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
06/17/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Delilah YaminTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Licensee, Delilah Yamin, to conduct inspection for capacity increase at Family Child Care Home (FCCH). Upon arrival, there were 7 children (2 infants/ 1 preschool-age/ 4 school-age) present which is compliant with small home capacity requirements. Licensee's mother, Maria Ramirez, was additionally present assisting with the children. Hours of operation are Monday-Friday 8:00AM-5:30PM.

Licensee states that adults over the age of 18 living in the home are: herself, her fiance (Jason Glovick), her father (Joseph Gonzalez), and her mother (Maria Ramirez). All adults have criminal record clearances and signed criminal record statements (LIC508).

Licensee 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 conducted tour of inside of FCCH during today's inspection and home was observed to be clean, orderly, and safe for the day care children. Off limits inside of the home include: attached garage, 2 bedrooms, 1 bathroom, and entire second story. Stairs to the second story are properly barricaded. Smoke alarm and carbon monoxide detectors are functioning and FCCH is equipped with 3A40BC fire extinguisher. Fire pull station is properly installed near front entrance of the home. Fire Clearance for large capacity was conducted and approved on 6/3/2022 by Santa Clara Fire Department and there are no conditions for fire clearance. The home is current equipped with 3 pack n' plays, 3 high chairs, and 8 cots. All food is brought by the children enrolled, however water is provided by the facility. There are currently no children who require medication or Incidental Medical Services (IMS).
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2022
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: YAMIN, DELILAH
FACILITY NUMBER: 434416317
VISIT DATE: 06/17/2022
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LPA conducted tour of outside of FCCH during todays inspection. Off limits outside the home include: both side yards and outside of fenced area for children. Licensee's pet dog is leashed, fenced off, and inaccessible to children in the backyard.

A file review was conducted for the staff that will be assisting Licensee at the home for large capacity. LPA advised Licensee that any staff member who will be alone with the children must have current CPR/First-Aid certificates. LPA obtained copy of children's roster (LIC9040) and reminded Licensee to update roster and paperwork for children prior to enrollment at the home. LPA reviewed capacity and staffing requirements for large family child care home with Licensee and provided copy of regulation. (CCR-102416.5 Staffing Ratio and Capacity) LPA provided Licensee with copy of Entrance Checklist (LIC126) for review of file requirements for FCCH.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The Licensee states that she does not transport any day care children. LPA reminded Licensee that children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Exit interview conducted and report was reviewed with the Licensee, Delilah Yamin.

As a result of todays inspection, no deficiencies were cited.

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.

LPA advised Licensee that increase in capacity will be given upon manager review and obtaining the following documents:

-Updated facility sketch (LIC999A) for yard at FCCH (provided to Licensee)
-Current Mandated Reporter certificate and proof of tDap for Licensee's mother, Maria Ramirez
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
LIC809 (FAS) - (06/04)
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