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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416720
Report Date: 07/30/2024
Date Signed: 07/31/2024 08:15:46 AM

Document Has Been Signed on 07/31/2024 08:15 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CRUZ, KARINAFACILITY NUMBER:
434416720
ADMINISTRATOR/
DIRECTOR:		KARINA, CRUZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 717-3618
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
07/30/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Karina CruzTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Anna Morales conducted an Unannounced Case Management Visit and was greeted by Licensee Karina Cruz. Present were two staff and nine children ( three infants and six preschool aged children). Licensee submitted a request for Bedrooms # 2 and #3 for day care use. A fire clearance was granted on July 9, 2024. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393) and Personal Rights (LIC 613A). Facility's operating days and hours are Monday to Friday 7:30am- 6:00pm. LPA observed smoke detector/carbon monoxide and a charged fire extinguisher. Last disaster drill was July 2, 2024. LPA observed current children's roster.

LPA observed bedrooms #2 and #3, and Licensee informed LPA that Bedroom's 2 and 3 will be for used for nap time. LPA observed two portable cribs inside the bedroom #2. LPA informed the Licensee that 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. Children have access to the day care area( living rooms),hallway bathroom and patio. Off limits is the kitchen and master bedroom and bathroom. Off limits in the outside is the garage and the right side of the house. LPA observed that the Licensee has appropriate toys and furnishings. 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.

LPA observed that the Licensee and her staff have current Mandated Reporter Training. (Licensee's expires on on 8/15/2025). Licensee's Pediatric First Aid/CPR expires on 3/13/25. No deficiencies cited, exit interview conducted and the report was reviewed with Karina Cruz.
A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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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