434416724-7-11-2023-07-CC-ALOZ-CTMQCB-20230711120251

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416724
Report Date: 07/11/2023
Date Signed: 07/11/2023 12:02:58 PM

Document Has Been Signed on 07/11/2023 12:02 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	NISHIMUTA, YOKO		FACILITY NUMBER:	434416724
ADMINISTRATOR:	YOKO, NISHIMUTA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 460-4714
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95124
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	07/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Yoko Nishimuta		TIME COMPLETED:	12:20 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 Licensee,Yoko Nishimuta for an unannounced Required – 1-year annual inspection. LPA was granted access to the home by the Licensee. LPA also observed 11 children (2 infants and 9 preschool) and 2 adult assistants (one of the assistants is the licensee's mother) in the home during today's inspection. Licensee was operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 9am - 6pm. The adults residing in the home are the licensee, licensee's mother, and licensee's son. LPA obtained a current copy of the Child Care Facility Roster and reviewed the Fire/Disaster drill log during today's inspection. The last drill was completed on 4/1/23. Licensee states that she does have liability insurance for the day care through Markel Insurance Company. Licensee and her assistants have current CPR and First Aid certifications which expire 6/12/24, 6/12/24, and 4/15/25. Licensee has the required vaccines (MMR, Tdap, TB, and flu) and is current with her Mandated Reporter Training for Child Care Workers which expires 12/30/24. Adult assistants also have the required vaccines (MMR, Tdap, TB, & flu) and are current with their Mandated Reporter Training for Child Care Workers (exp. 12/30/24 and 3/27/25). LPA reviewed 11 children's files and the files were complete with the required forms. LPA reviewed the 2 assistants and licensee's file. The files were complete with the required forms. LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408) 460-4714. 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. LPA did not observe any stairs or wall heaters inside the home. The off limit areas inside the home are the 3 bedrooms, 1 bathroom, kitchen, laundry room, and garage. Off limit areas outside the home is the gated right side of the backyard that includes the storage shed. ------------------------------------continued on page 2-----------------------------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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: NISHIMUTA, YOKO	FACILITY NUMBER: 434416724
	VISIT DATE: 07/11/2023

NARRATIVE

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LPA observed a fully charged 2A10BC fire extinguisher and working smoke/carbon monoxide detectors. There are no bodies of water and the backyard is fenced. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored in the gated off limits kitchen area and are inaccessible to children. Licensee states that she does/does not administer any medications to the day care children. Licensee has a first aid kit in the home and has a touchless thermometer. Licensee states that nobody smokes, and she understands that smoking is prohibited in the home.

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: 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 the licensee, and she understands that they must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her 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 dining room area with one of the assistants if necessary due to illness or communicable disease. Licensee states that she does not transport any day care children. Licensee understands 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.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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: NISHIMUTA, YOKO	FACILITY NUMBER: 434416724
	VISIT DATE: 07/11/2023

NARRATIVE

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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 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.

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. Licensee did not know she was required to keep a 15 minute sleep log for infants 2 years old and younger, she thought the regulation was 1 years old and under. LPA advised licensee to start keeping the 15 minute sleep log starting today for infants 2 years old and younger, and submit a copy to licensing.

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 was conducted and report was reviewed with the Licensee, Yoko Nishimuta.

There is a deficiency that was 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: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/11/2023 12:02 PM - It Cannot Be Edited

Created By: Ashley Lopez On 07/11/2023 at 11:30 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: NISHIMUTA, YOKO	FACILITY NUMBER: 434416724
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee does not have a 15 minute infant sleep log for children in care 2 years old and younger which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/21/2023
	Plan of Correction
1 2 3 4	Licensee stated she will submit a copy of the 15 minute infant sleep log for the children 2 years old and younger to licensing by the due date 7/21/23.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Ashley Lopez

LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: NISHIMUTA, YOKO	FACILITY NUMBER: 434416724
	VISIT DATE: 07/11/2023

NARRATIVE

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LPA observed a fully charged 3A40BC fire extinguisher and working smoke/carbon monoxide detectors. There is a barricaded fire place in the home, no bodies of water, and fenced backyard. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are located in the gated off limits kitchen area and are inaccessible to children. Licensee states that she does administer any medications sometimes to the day care children. She asks parents for doctors note and keeps medicine in a box inaccessible to children. Licensee has a first aid kit in the home and a touch less thermometer. Licensee states that nobody smokes, and she understands that smoking is prohibited in the home.

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: 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 the Licensee, and she understands that they must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her 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 dining room area with an assistant if necessary due to illness or communicable disease. Licensee states that they do not transport any day care children. Licensee understands 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.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC809 (FAS) - (06/04)

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