434416385-7-7-2023-07-CC-ALOZ-CTHPWR-20230707114110

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416385
Report Date: 07/07/2023
Date Signed: 07/07/2023 11:41:19 AM

Document Has Been Signed on 07/07/2023 11:41 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	GOMEZ, LISETTE & MARISOL		FACILITY NUMBER:	434416385
ADMINISTRATOR:	GOMEZ, LISETTE & MARISOL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 603-5063
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95124
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	07/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Lisette & Marisol Gomez		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Ashley Lopez met with Licensees, Lisette and Marisol Gomez for an unannounced Required – 1-year annual inspection. LPA was granted access to the home by the Licensees. LPA also observed 8 of children (2 infants and 6 preschool) in the home during today's inspection. Licensees were operating within their capacity and ratio requirements. LPA observed the required postings near the front entrance to the home. Days and hours of operation are Monday - Friday from 6:00am - 6:00pm. The licensees state they are the only adults residing in the home. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on 6/13/23. Licensees state that they do have liability insurance for the day care through DC Insurance and LPA observed a valid policy verifying coverage. Licensees have current CPR and First Aid certifications which expire 12/10/23. Licensees have the required vaccines (MMR, Tdap, TB, & flu declination) and is current with their Mandated Reporter Training for Child Care Workers which expire 1/2024 and 9/2023. LPA reviewed 8 children's files and the files were complete with the required forms. LPA reviewed both licensees files, they were complete with the required forms. LPA toured the indoor and outdoor areas of the home during today's inspection. Licensees have a working telephone in the home (408) 603-5063. The home is clean and orderly, and safe for the day care children. There are safe & age-appropriate toys, play equipment, and materials for the children in the home. There are no stairs inside the home. LPA did observe a wall heater inside the home, licensee stated they do not use it. LPA advised licensees that if they decide to use the wall heater they will need to barricade and make it inaccessible to the children. Off limit area inside the home is the garage. Off limit areas outside the home are the locked storage shed and the gated right side of the backyard.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GOMEZ, LISETTE & MARISOL	FACILITY NUMBER: 434416385
	VISIT DATE: 07/07/2023

NARRATIVE

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LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. Licensees state that they do not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are in the garage, an off limit area and are inaccessible to children. Licensee states they provide breakfast, lunch, snack, and sometimes a light dinner depending on how many children stay until closing time. Licensees have a first aid kit in the home. Licensee states that nobody smokes, and they understands that smoking is prohibited in the home.

Licensees state that they do not administer any medications to the day care children. Incidental Medical Services (IMS) policy was briefly 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/.

Supervision of children was discussed with licensees, and they understand that they must be present in the home during day care hours and ensure that the children are supervised at all times. Licensees understands their capacity/ratio options and they understand that they cannot have more than 14 children present in the home. Licensee states that a child will be isolated in the kitchen if necessary due to illness or communicable disease and contact parent right away. Licensee states that they do not transport any day care children. Licensees understand that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Licensees were 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.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GOMEZ, LISETTE & MARISOL	FACILITY NUMBER: 434416385
	VISIT DATE: 07/07/2023

NARRATIVE

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Licensees are familiar with the Infant Safe Sleep regulations. LPA reviewed the Infant nap check log and advised licensees about requesting a sleep sack from licensing. LPA discussed the safe sleep regulations with licensee 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 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

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with the Licensees Lisette and Marisol Gomez.

No deficiencies issued during today's inspection. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC809 (FAS) - (06/04)

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