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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416686
Report Date: 08/07/2026
Date Signed: 08/07/2026 12:40:42 PM

Document Has Been Signed on 08/07/2026 12:40 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MEDINA, MACYETFACILITY NUMBER:
434416686
ADMINISTRATOR/
DIRECTOR:		MACYET MEDINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 912-5163
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
08/07/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:MEDINA, MACYETTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 8/7/2026, Licensing Program Analyst (LPA) Liridon Fici (Doni) conducted an unannounced Annual Inspection and met with Licensee, MEDINA, MACYET and informed her of the purpose of today’s visit. LPA gathered a census during the visit. LPA also reminded Licensee to make sure her Annual Fee is paid yearly. LPA did not observe any animals in the home.

During today's visit, was the Licensee and three (3) children present; two (2) out of the three (3) children are the Licensee's own children. Licensee stated that she, and her spouse are the adults residing in the home; Licensee mentioned there are four (4) minors living in the home also with the Licensee. All are fingerprint cleared and associated to the facility. Parents will enter from the front of the house. The home is a second-story home. Days and hours of operation are Monday–Friday from 8:00 AM to 5:00 PM. LPA did observe a swimming pool located in the backyard which is fenced at least 5 feet high and locked; LPA toured the pool and observed an alarm in the water which goes off when water touches it along with a daily safety check log, rescue pole and life ring that meets pool safety regulations.

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...


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Gladys Kuizon
Liridon Fici
DATE: 08/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: MEDINA, MACYET
FACILITY NUMBER: 434416686
VISIT DATE: 08/07/2026
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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 per 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.

LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a cell phone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. The backyard is enclosed by a fence and is gated. Off-limits to the home include: entire upstairs, bedrooms, kitchen, dining room, laundry /garage area, and backyard swimming pool. The backyard is used for children and is enclosed by fencing for the safety of children.

LPA reminded Licensee, and she understands, that she needs to supervise children when using the backyard at all times. LPA reminded Licensee to check all plastic play structures for any cracks and/or damages that can injure a child in care. Licensee mentioned to LPA that she does not transport children at all and understands no child shall be left in a car unattended for any reason.

There is a designated area located in the kitchen/ living room of the home where child(ren) can be isolated if exhibiting any signs of illness until the child's parent(s) pick them up. LPA reviewed the Fire/Disaster drill log during today's inspection; the drill was conducted on 8/1/2026.

Licensee provides breakfast and lunch, along with snacks for the children. Licensee stated she does not allow outside food/drinks to be brought into the day care for the children. LPA advised Licensee to make sure all children's items have their names labeled on them. LPA observed a first aid kit in the day care. Staff stated that nobody smokes, and she understands that smoking is prohibited in the day care.


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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Liridon Fici
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026
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: MEDINA, MACYET
FACILITY NUMBER: 434416686
VISIT DATE: 08/07/2026
NARRATIVE
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LPA observed a fully charged 3A4BC fire extinguisher, with working smoke and carbon monoxide detectors (update fire extinguisher annually). The Licensee stated that there are no weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.

LPA reviewed one (1) child's file and observed that Parent’s Rights forms, immunization records, consents for emergency medical treatment, and identification forms are in each file. Licensee’s file was reviewed for the following records: Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), and immunization records showing immunity to measles (MMR), pertussis (Tdap), and influenza (or statement declining influenza). Licensee has current Pediatric CPR/First Aid that expires on 9/14/26, along with current Mandated Reporter Training that expires on 1/17/2027. LPA informed Licensee that Mandated Reporter Training and First Aid/CPR are mandatory and should be renewed every 2 years; Mandated Reporter Training can be completed on www.mandatedreporterca.com.

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: U.S. 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/. Licensee stated she is not interested in caring for children who are in need of IMS plans.

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... Page 3 of 5.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Liridon Fici
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: MEDINA, MACYET
FACILITY NUMBER: 434416686
VISIT DATE: 08/07/2026
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https://www.cpsc.gov/ and recommended she register all infant devices with the CPSC to be notified of any recalls on purchased equipment. LPA informed Licensee that Infants 12 months (1 Year old) and under will have an Lic9227 (Individual Infant Sleep Plan) in the infants file and conduct 15-minute sleep logs. After the infant is 1 years old and above, Licensee will continue the 15-minute sleep logs until age 2 years old.

Supervision of children was discussed with Licensee, and she understands that she must be present in the home during day care hours and ensure that the children are always supervised. Licensee understands her capacity options, and she understands that she cannot have more than 14 children in the home at any time. Licensee understands that if she transports children via vehicle, children cannot be left in parked vehicles unattended at any time.

LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for updates.

LPA discussed the requirements of AB 633 with the Licensee, and she understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed “zero tolerance” related regulations and advised that the assessment of an immediate $500 per day civil penalty applies for any violation of a “zero tolerance” related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

The Licensee was informed of the MyChildCarePlan.org site, 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.


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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Liridon Fici
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: MEDINA, MACYET
FACILITY NUMBER: 434416686
VISIT DATE: 08/07/2026
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PINs), Program Quarterly Update Newsletters, and other important information communication platforms. To receive important licensing-related information, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe (cdss.ca.gov) and select the Child Care option to receive email communication.

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.

On this date, 8/5/2026, the California Attorney General – Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California’s Megan’s Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross-reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

During the exit interview, the Licensee confirmed that there are no registered sex offenders living in the facility, and LPA completed the RSO profile in FAS. No deficiencies were cited during today's visit. A Notice of Site Visit was given to the licensee, and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted, and report was reviewed with the Licensee, MEDINA, MACYET along with appeal rights provided. Page 5 of 5.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Liridon Fici
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026
LIC809 (FAS) - (06/04)
Page: 6 of 6