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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416715
Report Date: 01/25/2023
Date Signed: 01/25/2023 11:13:54 AM

Document Has Been Signed on 01/25/2023 11:13 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SANCHEZ, JUANITAFACILITY NUMBER:
434416715
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
01/25/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:49 AM
MET WITH:Juanita SanchezTIME COMPLETED:
11:25 AM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management- Licensee Initiated inspection. LPA met with Licensee Juanita Sanchez and explained the reason for the inspection. The purpose of this inspection is Licensee is applying for a large Family Child Care Home (FCCH). Licensee has been licensed since 05/12/2021; therefore has at least a year of experience has a small FCCH operator to apply for a large FCCH. A fire clearance was granted on 11/29/2022. Present during today's inspection were Licensee and one child, who was infant age.

An annual inspection was conducted on 06/03/2022.

LPA toured the home with Licensee. The off-limit area of the home is Bedroom #1. Licensee will submit an updated LIC 999 to reflect the change. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible to children. LPA discussed with Licensee that anything that states to keep out of reach of children needs to be inaccessible, such as laundry detergent and medication. There are toys for children. LPA discussed with Licensee that baby bouncers are not allowed in the home. Licensee removed baby bouncer during today's inspection. LPA also discussed with Licensee the safe sleep regulations and informed Licensee that the door to where infants are sleeping needs to be open. Upon arrival, the door to Bedroom #1 was closed. Licensee went to get the infant who had woken up from a nap. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Licensee stated that there are no weapons, such as firearms, in the home. Licensee uses the patio. There were no bodies of water observed during today's inspection.

------------------continues on 809 dated 01/25/2023 page 2----------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: SANCHEZ, JUANITA
FACILITY NUMBER: 434416715
VISIT DATE: 01/25/2023
NARRATIVE
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-----------------continuation of 809 dated 01/25/2023 page 1----------------------

LPA discussed with Licensee about the maximum capacity requirement of a Large Family Child Care Home License. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home shall be either:
(1) 12 children, no more than four of whom may be infants; or
(2) more than 12 and up to 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age and there are no more than three infants being cared for during any time when more than 12 children are being cared for.

When Licensee have more than 12 and up to 14 children in the home, Licensee must notify the parent using the form LIC9150 “Parent Notification Additional Children in Care." LPA reminded Licensee that when Licensee does not have a Helper, Licensee can only care for up to 8 children at any one time in the home.

The adults living in the home are Licensee and her adult daughter. Licensee's minor grandchild also lives in the home. All adults have cleared fingerprints. Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

--------------continues on 809 dated 01/25/2023 page 3---------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 01/25/2023 11:13 AM - It Cannot Be Edited


Created By: Samantha Yip On 01/25/2023 at 10:28 AM
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: SANCHEZ, JUANITA
FACILITY NUMBER: 434416715

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2023
Section Cited
HSC
1596.866(b)

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Day care center directors and licensees of family day care homes shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric CPR issued by the American Red Cross, the American Heart Association, or by a training program that has been approved by the Emergency Medical Services Authority pursuant to this section and Section 1797.191 shall be onsite at all times when children are present at the facility, ...
This requirement is not met as evident by:
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By POC 02/27/2023, Licensee will submit proof of CPR/1st Aid to Licensing.
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Based on record reviews, Licensee's CPR/1st Aid expired on 11/07/2022, which poses a potential health and safety risk to children in care.
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Type B
02/01/2023
Section Cited
CCR102425(j)(5)

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If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.
This requirement is not met as evident by:
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By POC 02/01/2023, Licensee will send statement that she understands the safe sleep regulation and that the door to the room needs to remain open
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Based on observation, upon arrival, infant was sleeping in Bedroom #1. The door was closed, which poses a potential health and safety risk to children in care.
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at all time.
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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023


LIC809 (FAS) - (06/04)
Page: 3 of 4
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: SANCHEZ, JUANITA
FACILITY NUMBER: 434416715
VISIT DATE: 01/25/2023
NARRATIVE
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----------------continuation of 809 dated 01/25/2023 page 2-----------------------

Licensee's Mandated Reporter training and immunization records are on file. Licensee's CPR/1st Aid expired on 11/07/2022.

Licensee will submit the following:
- proof of CPR/1st Aid
- updated facility sketch

As a result of this inspection, type B citations were issued. Exit interview conducted and report was reviewed with Licensee Juanita Sanchez. A notice of site visit has been issued and must remain posted for 30 days.

Licensee was informed that upon receipt of Licensing Management's approval, a license for a Large Family Child Care Home will be granted and issued to Licensee upon completion of the following:
- completion of CPR/1st Aid
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4