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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416759
Report Date: 03/28/2024
Date Signed: 03/28/2024 01:19:28 PM

Document Has Been Signed on 03/28/2024 01:19 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GUTIERREZ CASTRO, OMAR & SALAS, ANGELFACILITY NUMBER:
434416759
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 4DATE:
03/28/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Angel Salas and Omar Gutierrez CastroTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Deanna Villagrana and Martha Jimenez-Villanueva met with licensees Angel Salas and Omar Gutierrez Castro for an annual/random and increase of capacity visit. LPAs explained the nature of today’s inspection to them. Present were licensees and licensee Omar's adult brother and his parents who are visiting from Mexico. Omar states parents arrived today and will be leaving tomorrow. Days and hours of operation are Monday to Friday, 6:00am to 7:30pm. The adults that reside in the home are licensees and Omar's adult brother.

A review of staff records on 03/26/2024 indicates that all Facility staff or other record and child abuse index clearances or exemptions. Licensees Angel Salas and Omar Gutierrez Castro were 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.

LPAs toured the indoor and outdoor areas of the home during today’s inspection. LPAs observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPAs observed barricaded stairs in the home. LPAs observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items inside the home are stored inaccessible to children. LPAs observed a fully charged 3A40BC fire extinguisher and a working combo smoke and carbon monoxide detector. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: upstairs master bedroom/bath, three bedrooms, one bathroom, laundry room and downstairs attach garage. There are no bodies of water. Backyard is fenced. Off limits outdoor: left side of home that is fenced off to children. Licensee states no animals in the home. LPAs observed licensees have a current CPR and First Aid certification and completed Mandated Reporter training. Angel Salas CPR and First Aid certification
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: GUTIERREZ CASTRO, OMAR & SALAS, ANGEL
FACILITY NUMBER: 434416759
VISIT DATE: 03/28/2024
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expires 7/24/2024 and Omar Gutierrez Castro's expires on 03/09/2025. Both completed Mandated Reporter training on 02/16/2023.

LPAs observed a current roster of the children. LPAs observed a fire and disaster drill log was last completed on 06/27/2023. LPAs reviewed seven children's files and observed all forms are completed and children have current immunization records. Licensees states day care is insured with Next and expires on August 2024. LPAs discussed SB792 Immunization Requirements and observed licensee have immunization records on file.



Supervision of children was discussed with licensees and they understand that they must be present in the home during day care hours and ensure that the children are supervised at all times. Licensees understand their capacity options and they understand that they cannot have more than eight children in the home at any time. Licensees understand if they transport children via vehicle, children cannot be left in parked vehicles unattended at any time.

LPAs discussed the safe sleep regulations with licensee Angel Salas and Omar Gutierrez Castro 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. LPAs also informed licensee Angel Salas and Omar Gutierrez Castro 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.


LPAs discussed Zero Tolerance related regulations with licensee Angel Salas and Omar Gutierrez Castro and were advised of the assessment of $500 immediate civil penalty and an ongoing $100 per day per violation continues until the violation(s) is corrected. Incidental Medical services (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, 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: http://www.ada.gov/childqanda.htm
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
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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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GUTIERREZ CASTRO, OMAR & SALAS, ANGEL
FACILITY NUMBER: 434416759
VISIT DATE: 03/28/2024
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Exit interview conducted and report was reviewed with the licensees Angel Salas and Omar Gutierrez Castro. During the exit interview, the LICENSEES, confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

The following type B deficiency was cited on the attached page (809-D). Licensees were informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made. LPAs provided ratio/capacity chart to licensees. Licensees were informed that once deficiency is cleared, a large Family Home License will pending Manager's approval.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/28/2024 01:19 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 03/28/2024 at 12:40 PM
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: GUTIERREZ CASTRO, OMAR & SALAS, ANGEL
FACILITY NUMBER: 434416759

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. LPAs observed a fire and disaster drill log was last completed on 06/27/2023 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/04/2024
Plan of Correction
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Licensee will submit an updated fire and disaster drill log to CCLD by POC date.

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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2024


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