434416720-9-28-2022-07-CC-JGSS-CJPRQ7-20220928131305

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416720
Report Date: 09/28/2022
Date Signed: 09/28/2022 01:13:13 PM

Document Has Been Signed on 09/28/2022 01:13 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:	CRUZ, KARINA		FACILITY NUMBER:	434416720
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 4	CENSUS: 3	DATE:	09/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Karina Cruz		TIME COMPLETED:	01:25 PM

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Licensing Program Analyst (LPA) James Santos conducted an unannounced Required 1 Year inspection and met with Licensee, Karina Cruz. The inspection is also in response to the Licensee's application/request for a capacity increase from a Small Family Child Care Home to a Large Family Child Care Home.

LPA toured the entire home with Licensee. The home is a one story building. The main areas of the home used for day care are the living room and the extended patio deck areas. The day care children are able to use bathroom #2(located by the hallway area). Off limit areas inside the home are all 3 bedrooms, bathroom #1(located in the master bedroom), kitchen area and the garage. LPA observed a fully charged fire extinguisher, two functioning combination smoke/carbon monoxide detectors, fire alarm and emergency first aid kits. The home was observed to be in good order and safe for the day care children. The home has sufficient toys and play equipment for the day care children. Licensee stated that there are no weapons and poisons in the home. Cleaning products, toxic agents, medications, and sharp objects are stored and inaccessible to children.

The backyard/outdoor playground area has a tree that provides a shaded area. The outside area is also surrounded and enclosed by a fence and was observed to be free of hazards. The outdoor play equipment were observed to be in good condition. There are no bodies of water observed. Licensee has a pet dog that is vaccinated and will be kept in off limit areas or in the crate during day care hours.

The adults that reside in the home are the Licensee and her Aunt who is also her helper. Licensee's and her Aunt's records were reviewed which include fingerprint clearance, TB clearance, immunization (Measles, Pertussis, and Flu) record, CPR/First Aid and Mandated Reported Training.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

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: CRUZ, KARINA	FACILITY NUMBER: 434416720
	VISIT DATE: 09/28/2022

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LPA reviewed the children's roster in care and reviewed the records which include Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice and Immunization record.

Licensee was advised on the regulations that smoking, baby walkers, bouncers, excersaucers and other similar items are not allowed. Forms of discipline were discussed. Licensee understands that children's personal rights should not be violated. Isolation of sick children, supervision of children, capacity options, transportation of children were also discussed. Per Licensee, she does not provide transportation and is also not planning to provide (Incidental Medical Services) IMS at this time.

LPA discussed the safe sleep regulations. Safe sleep information can be found on the webpage at:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

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.

No deficiencies cited during today's inspection. Exit interview conducted and this report was reviewed and a copy was provided with Licensee, Karina Cruz.

Licensure of a Large (capacity 14) Family Child Care Home will be approved upon management's approval.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

LIC809 (FAS) - (06/04)

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