434416766-3-25-2022-07-CC-SYIP-CCURGP-20220325130104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416766
Report Date: 03/25/2022
Date Signed: 03/25/2022 01:01:11 PM

Document Has Been Signed on 03/25/2022 01:01 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:	ESQUIVEL, MARIA		FACILITY NUMBER:	434416766
ADMINISTRATOR:	MARIA, ESQUIVEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 665-2995
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 9	CENSUS: 5	DATE:	03/25/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Maria Esquivel		TIME COMPLETED:	01:05 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) Samantha Yip conducted an announced pre-licensing inspection. LPA met with Applicant Maria Esquivel and explained the reason for the inspection. The purpose of this inspection is Applicant is applying for a change of location. Applicant is currently licensed under #434415725 at 872 Ryan Court, Gilroy 95020. A fire clearance was granted on 03/09/2022. Present during today's inspection were five children, Applicant, and her son. Two of the children are from the same family. LPA discussed with Applicant about how her license does not transfer when she does a change of location. LPA discussed that she is only able to take care of one family if she does have a license. LPA discussed with Licensee regulation for License Exemption. Licensure is required before family child care is provided except if she is providing care for children of only one family. There is board to post required postings. The hours of operation are Monday through Friday 7AM to 5PM. There is working phone. Applicant rents the home and will send proof of lease agreement once she obtains a copy from her Landlord. Applicant requested to change her daycare insurance to her current address, but is still waiting her for insurance to send her the updated insurance. Applicant understands that she needs to use the Affidavit for Liability Insurance if she does not have daycare insurance. LPA toured the inside and outside of the home with Applicant. The off-limit areas of the home inside are two rooms, master bedroom, the master bathroom, and garage. There are no stairs in the home. There is a fireplace in the home, which is barricaded. ------------------------continues on 809 dated 03/25/2022 page 2---------------------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

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: ESQUIVEL, MARIA	FACILITY NUMBER: 434416766
	VISIT DATE: 03/25/2022

NARRATIVE

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-------------------------continuation of 809 dated 03/25/2022 page 1----------------------------

Disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible. There is a crib in the home. LPA did not observe anything hanging on the crib or loose articles. LPA did observe that there was a baby bouncer and a baby seat in the home. LPA discussed with Applicant that baby bouncers and baby seats are not permitted in the home. Applicant's son moved the items to the garage, which is off-limits. LPA observed that there is a piece of the flooring that was missing between the door of the bathroom, which could pose as a tripping hazard. Applicant place a piece of yoga mat in-between the gap. Applicant stated that she will place a piece of panel and send proof once it fixed. Applicant stated that there are no weapon, such as firearms, stored in the home. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. LPA reminded Applicant that fire/disaster drill need to be conducted every six months.

Applicant plans on using the backyard, but still needs to anchor the play structure to the ground. Applicant stated that backyard will be off-limits until the backyard is ready. LPA observed that on the left back corner of her fence is missing a panel. Applicant stated that she will fix it and send proof to Licensing. LPA also observed that there is a fence that separates the right side of her yard. LPA discussed with Applicant that any sheds that have poisons, chemicals, and tools needs to be locked. Applicant understands that Licensing needs to inspect the backyard before she can make it on-limits to the children. Applicant stated that she will notify Licensing once she is ready to have her backyard on-limits. An updated LIC 999A was obtained during today's inspection.

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 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.

-----------------------continues on 809 dated 03/25/2022 page 3-------------------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

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: ESQUIVEL, MARIA	FACILITY NUMBER: 434416766
	VISIT DATE: 03/25/2022

NARRATIVE

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Applicant does not plan on transporting children, but understands that children cannot be left alone and unattended in parked vehicles. The form of discipline Applicant plans on using is time-out, redirection, and talking to the children. Applicant understands that children's personal right should not be violated, including no corporal punishment.

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: http://www.ada.gov/childqanda.htm

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

Entrance Checklist was provided to the applicant.

Applicant has a valid CPR/1st Aid, which expires on 08/28/2023. Her immunization records for measles and pertussis are on file; along with her Health and Safety certificate. Applicant completed the Mandated Reporter training on 12/16/2021. LPA reminded Applicant that Mandated Reporter training requires renewal every two years.

The adults 18 and over living in the home are Applicant and her son. Applicant submitted the LIC 9182: Criminal Background Transfer Request and a valid ID for herself and her son during today's inspection. Adults have TB clearance. Applicant 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.

-----------------------continues on 809 dated 03/25/2022 page 4---------------------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

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: ESQUIVEL, MARIA	FACILITY NUMBER: 434416766
	VISIT DATE: 03/25/2022

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Applicant will submit the following:

- lease agreement

- flooring by the door of the bathroom is fixed

Based on LPA observations of the items noted above, the facility physical plant has been APPROVED and final licensure is pending Community Care Licensing Management Approval.

As a result of this inspection, a Type B citation was cited. Exit interview conducted and report was reviewed with the Applicant, Maria Esquivel.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/25/2022 01:01 PM - It Cannot Be Edited

Created By: Samantha Yip On 03/25/2022 at 12:23 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: ESQUIVEL, MARIA	FACILITY NUMBER: 434416766
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102358(a)(1)

Licensure is required before family child care is provided except in the following situations relative to family child care homes as specified in Health and Safety Code Section 1596.792: (1) Any family day care home providing care for the children of only one family in addition to the operator's own children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record reviews, the licensee did not comply with the section cited above in 3 out of 5 counts. LPA observed that there were five children present, whom two were from the same family, which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/25/2022
	Plan of Correction
1 2 3 4	Deficiency was corrected during today's inspection. Applicant applied for a change of location, but was not licensed yet.

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:

Samantha Yip

LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

LIC809 (FAS) - (06/04)

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