434416846-11-15-2023-07-CC-SYIP-CXM44A-20231115174602

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416846
Report Date: 11/15/2023
Date Signed: 11/15/2023 05:46:10 PM

Document Has Been Signed on 11/15/2023 05:46 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:	BARRIOS, KAROL		FACILITY NUMBER:	434416846
ADMINISTRATOR:	KAROL, BARRIOS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 281-5391
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95110
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	11/15/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Karol Barrios		TIME COMPLETED:	11:30 AM

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 Karol Barrios and Guillermo Barrenechea and explained the visit. The purpose of this inspection is Applicant is applying for a large Family Child Care Home (FCCH). Applicant does have one year of experience working at a child care center to apply for a large FCCH. A fire clearance was granted on 10/17/2023. There is board to post required posting, such as notification of parent's rights. The hours of operation are Monday through Friday 7:30AM to 6:00PM. There is working phone in the home, which is (669)230-6957. LPA toured the inside and outside of the home. The off-limit areas of the home are the kitchen and the entire upstairs. There are stairs in the home. There are doors prior to the stairs to make it off-limits. Applicant understands that the door needs to be closed at all time. Cleaning supplies, disinfectant, and other items that could pose a risk to children were inaccessible to children. There are toys and equipment for children. There are cribs in the home. Applicant understands that there needs to be one crib per infant and that they cannot share cribs. There were no baby walkers observed during today's inspection. Applicant understands that smoking is not permitted in the home. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Applicant stated that there are no weapons, such as firearms, stored in the home. Applicant plans on using Back Room 2 to isolate any sick children and the bathroom next to the kitchen for any sick children. ----------------CONTINUES ON 809 DATED 11/15/2023 PAGE 2------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BARRIOS, KAROL	FACILITY NUMBER: 434416846
	VISIT DATE: 11/15/2023

NARRATIVE

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--------------CONTINUATION OF 809 DATED 11/15/2023 PAGE 1---------------

The backyard is fenced. The off-limit areas outside are the left side of the yard, the detached garage, and driveway. There is a play structure/swings outside, which is anchored to the ground. There were no bodies of water observed 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.

The form of discipline Applicant plans on using is talking to the children and giving them breaks. Applicant understands that children's personal rights cannot be violated. Applicant does not plan on transporting children, but understands that children cannot be left alone and unattended in parked vehicles.

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.

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) or (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.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BARRIOS, KAROL	FACILITY NUMBER: 434416846
	VISIT DATE: 11/15/2023

NARRATIVE

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--------------- CONTINUATION OF 809 DATED 11/15/2023 PAGE 2-------------

The applicant provided proof of control of property. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

The adults 18 and over living in the home are Applicant and her boyfriend. All adults have cleared criminal record clearance and TB test. 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, 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.

On this date, 11/15/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BARRIOS, KAROL	FACILITY NUMBER: 434416846
	VISIT DATE: 11/15/2023

NARRATIVE

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---------------CONTINUATION OF 809 DATED 11/15/2023 PAGE 3------------

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 platforms.
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.

An updated LIC 279 was obtained during today's inspection.

Applicant will submit the following:
- LIC 999A for the upstairs

Applicant was advised that upon approval of Licensing Program Manager a license for a large family child care home will be granted. Exit interview conducted and report was reviewed with the applicant, Karol Barrios, and Guillermo Barrenechea.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

LIC809 (FAS) - (06/04)

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