434416750-10-13-2021-07-CC-SYIP-C7RU87-20211013152103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416750
Report Date: 10/13/2021
Date Signed: 10/13/2021 03:21:15 PM

Document Has Been Signed on 10/13/2021 03:21 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:	VALERIO, NINIVE		FACILITY NUMBER:	434416750
ADMINISTRATOR:	VALERIO, NINIVE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 707-0552
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 6	CENSUS: 2	DATE:	10/13/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Ninive Valerio		TIME COMPLETED:	01:10 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 Analysts (LPAs) Samantha Yip and Aman Sharma conducted an announced pre-licensing inspection. LPAs met with Applicant Ninive Valerio and explained the reason for the inspection. The purpose of this inspection is Applicant applied for a change of location and a change of capacity to a large Family Child Care Home (FCCH). Applicant is currently licensed at 985 Montebello Drive, F101, Gilroy, CA 95020 (facility number 434415863). Licensee has been licensed as a small FCCH since 04/2019; therefore, she meets the requirement to apply for a large FCCH. A fire clearance for 14 children was granted on 10/04/2021. Present during today's inspection were Applicant and her two children. There is a board to post required postings. LPA also observed COVID posters posted. Applicant rents the home and will send a copy of lease agreement to Licensing by 10/22/2021. Applicant stated that she plans on obtaining liability insurance. Applicant understands that she needs to use the Affidavit Regarding Liability Insurance to inform parents if she does not have daycare insurance. Applicant plans on using cell phone. The hour of operation are Monday through Friday 6AM to 6PM. LPAs toured in the inside and outside of the home with Applicant. The off-limit areas of the home are Room 1, laundry room, garage, the entire upstairs, and the left side of the backyard. There are stairs in the home, which are barricaded. There are no fireplaces in the home. LPAs observed that there are toys for children in care. Furniture were age-appropriate. There were no baby walkers observed in the on-limit areas for the children. Applicant understands that baby walker and smoking is not permitted in the home. -------------------CONTINUES ON 809 DATED 10/13/2021 PAGE 2--------------------------------

SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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: VALERIO, NINIVE	FACILITY NUMBER: 434416750
	VISIT DATE: 10/13/2021

NARRATIVE

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---------------------CONTINUATION OF 809 DATED 10/13/2021 PAGE 1-----------------------

There is fully charged fire extinguisher, functioning smoke detector, and carbon monoxide detector. Applicant stated that there are no weapons, such as firearms, stored in the home.
Applicant plans on using the backyard. Backyard is fenced. LPA observed that there is a metal cover over the line that leads from the air condition unit to the home. The metal cover has screws that are exposed on the other end. LPA discussed with Applicant about the air condition unit and the rose bushes and checking for any sharp edges. Applicant stated that she will put a screen over the air condition unit. Applicant stated that she will submit an updated LIC 999A: Yard to reflect the changes to the outside area.

Applicant does not plan on transporting children at this time, but understands that children cannot be left alone and unattended in parked vehicles.

The form of discipline Applicant plans on using is quiet time and reflection time. Applicant understands that children's personal rights cannot be violated, including no corporal punishment.

LPA discussed the safe sleep regulations with Applicant 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 Applicant of the importance of checking 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.

Applicant does not plan on providing Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, an Plan of Providing IMS must be submitted to Licensing. 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 publications: Commonly Asked Questions about Child Care Center and the ADA, available at: http://www.ada.gov/childqanda.htm.

-----------------CONTINUES ON 809 DATED 10/13/2021 PAGE 3-----------------------------

SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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: VALERIO, NINIVE	FACILITY NUMBER: 434416750
	VISIT DATE: 10/13/2021

NARRATIVE

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------------------CONTINUATION OF 809 DATED 10/13/2021 PAGE 2---------------------------

Applicant does have a valid CPR/1st Aid, which expires on 09/25/2023. Applicant's certificate for Preventive Health and Safety, Mandated Reporter training, and immunization record for pertussis and measles are on file. Applicant completed the Mandated Reporter training on 06/16/2021 and understands that it needs to renewed every 2 years. Applicant stated that she will submit either proof of influenza or a statement to decline flu shot to Licensing.

LPA provided Applicant with a Family Child Care Home packet with updated Licensing forms and reviewed with the Applicant. Department website: www. ccld.ca.gov provided to the Applicant. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, requirements for assistant/substitute, and immunization requirements for staff. LPA also discussed the requirements for healthy beverages in child care with Applicant. LPA reminded Applicant/Licensee that fire/emergency drills need to be conducted every 6 months and documented. LPA discussed COVID guidelines with Applicant during today's inspection.

The adults living in the home are Applicant and her spouse. Applicant also has two minor children. All adults have cleared criminal record, child abuse index, or exemption, and TB clearance. Applicant was reminded that all adults 18 and over living or working in the home, 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.

Applicant stated that she will submit:
- copy of lease agreement
- updated LIC 508 for herself and her spouse
- updated LIC 999A: Yard

An exit interview was conducted where this report was discussed and provided to Applicant Ninive Valerio. LPA advised Applicant that a license for a Large Family Child Care Home will be granted and issued upon review and approval of Licensing Program Manager.

SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

LIC809 (FAS) - (06/04)

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