434416766-3-23-2023-07-CC-SYIP-CQ7V49-20230323160557

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416766
Report Date: 03/23/2023
Date Signed: 03/23/2023 04:06:03 PM

Document Has Been Signed on 03/23/2023 04:06 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: 14	CENSUS: 11	DATE:	03/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:38 PM
MET WITH:	Maria Esquivel		TIME COMPLETED:	04:15 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 unannounced Required- 1 Year inspection. LPA met with Licensee Maria Esquivel and explained the reason for the inspection. Upon arrival, Licensee, her assistant, and four children, whom two were infant age were present at the facility. There were 6 more school-age children arrived shortly after. All adults present have cleared fingerprints. There is board to post required postings, such as license and notification of parents rights. The hours of operation are Monday through Friday 7AM to 5PM. Licensee is using her cell phone. LPA discussed with Licensee that if she is transport children and her assistant is with the children at the home that there needs to be a working phone. LPA toured the inside of the home with Licensee. The off-limit areas of the home are the garage, two bedrooms, master bedroom, and master bathroom. There is a fireplace, which is barricaded. Disinfectant, cleaning supplies, and other items that could pose a risk to children in care were observed to be inaccessible. LPA reminded Licensee that any disinfectant sprays and wipes or anything that states to keep out of reach of children needs to be inaccessible to children. There are toys and equipment for children. There were no baby walkers observed during today's inspection. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last disaster drill was conducted on 03/2023. Licensee stated that there are no weapons, such as firearms, stored in the home. -------------------continues on of 809 dated 03/23/2023 page 2------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 6

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: 03/23/2023

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
26
27
28
29
30
31
32

----------------continuation of 809 dated 03/23/2023 page 1-----------------------

Licensee stated that she uses the patio in her backyard. LPA inspected the backyard during today's inspection. The backyard is fenced. There is a play structure that is anchored to the ground. The off-limit areas outside is the right side yard. The backyard was observed to be safe for the children. LPA discussed with Licensee that during the pre-licensing inspection on 03/25/2022 that Licensee stated that the backyard would be off-limits. LPA discussed with Licensee that Licensing needs to come out to inspect any off-limit areas prior to the children using it. There were no bodies of water observed during today's inspection.

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. LPA reminded Licensee that sheets needs to be tight fitted and sheet needs to fit the mattress.

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

Licensee's assistant transports children and has a valid driver's license. Licensee understands that children cannot be left alone and unattended in parked vehicles.
-------------------continues on 809 dated 03/23/2023 page 3-----------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: 03/23/2023

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
26
27
28
29
30
31
32

--------------continuation of 809 dated 03/23/2023 page 2--------------------

A copy of the facility roster was obtained. Four (4) children's files were reviewed during today's inspection. The records reviewed include but not limited to LIC 9227, immunization records, and parent's rights.

Licensee and her assistant's file was reviewed during today's inspection. Licensee and her assistant have a valid CPR/1st Aid. Licensee's CPR/1st Aid expires on 08/2023 and her assistant's CPR/1st Aid expires on 02/05/2024. Licensee and her Assistant completed the Mandated Reporter training. Licensee completed it on 12/2021 and her assistant completed it on 04/23/2021. LPA reminded her that the Mandated Reporter training requires renewal every two years. Her assistant is missing immunization records for measles and pertussis. Licensee stated that she will have her assistant obtain vaccines and send proof to Licensing.

The adults living in the home are Licensee and her adult son. All adults have cleared fingerprints. Licensee 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.

As a result of this inspection, a Type A was cited. Exit interview conducted and report was reviewed with Licensee Maria Esquivel. A notice of site visit has been issued and must remain posted for 30 days.

LPA Samantha Yip informed Licensee, Maria Esquivel, that this report dated 03/23/2023 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Samantha informed the Licensee, Maria, to provide a copy of this licensing report dated 03/23/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC809 (FAS) - (06/04)

Page: 3 of 6

Document Has Been Signed on 03/23/2023 04:06 PM - It Cannot Be Edited

Created By: Samantha Yip On 03/23/2023 at 03:33 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: 03/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.3(a)(6)

Alterations to Existing Building or Grounds

(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care. Licensee stated that she is using her patio in her backyard. The backyard was listed as off-limits.
	POC Due Date: 03/23/2023
	Plan of Correction
1 2 3 4	Deficiency corrected during today's inspection. LPA inspected the backyard during today's inspection.

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: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC809 (FAS) - (06/04)

Page: 4 of 6