434416865-1-9-2024-07-CC-SYIP-CZBRWT-20240109122337

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416865
Report Date: 01/09/2024
Date Signed: 01/09/2024 12:23:43 PM

Document Has Been Signed on 01/09/2024 12:23 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:	PANAMENO, KATHERINE		FACILITY NUMBER:	434416865
ADMINISTRATOR:	KATHERINE PANAMENO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 507-9595
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 4	DATE:	01/09/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Katherine Panameno		TIME COMPLETED:	11:25 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 Katherine Panameno and explained the reason for the inspection. The purpose of this inspection is Applicant is applying for a change of location. Applicant is currently located at 515 West Iowa Avenue, Sunnyvale 94086. Present during today's inspection were Applicant, her spouse, and her five minor children. A fire clearance was granted on 01/02/2024. There is board to post required postings, such as notification of parents and license. The hours of operation are Monday through Friday 8:30AM to 5:30PM. LPA toured the inside and outside of the home with Applicant. The off-limit area of the home are the kitchen, garage, master bedroom, master bathroom, and closets in the hallway. The fireplace is barricaded. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible. LPA reminded Applicant that all medication and diaper creams need 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. Applicant stated that there are no weapons, such as firearms, stored in the home. Applicant does have a pet. Applicant will use either the dining room or the coach in the living room to isolate any sick children. Applicant plans on using the backyard. LPA observed that the fence on the right side of the is leaning and that are gaps in the fence. LPA also observed that there are gaps on the back fence and the left front side of the home. Applicant stated that she will make the backyard off-limits until fence is fixed. There is a play equipment outside, which is anchored to the ground. There were no bodies of water observed during today's inspection. -------------------CONTINUES ON 809 DATED 01/09/2024 PAGE 2---------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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 3

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: PANAMENO, KATHERINE	FACILITY NUMBER: 434416865
	VISIT DATE: 01/09/2024

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 01/09/2024 PAGE 1--------------

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, licensee, or facility representative] 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. PIN 20-23-CCLD was provided to Applicant. LPA observed that one of the play yard had a mattress that was not firm.

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.

Applicant does plan on transporting children. Applicant does have a valid driver's license. Applicant understands that children cannot be left alone and unattended in parked vehicles. Car seat law was provided to Applicant.

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 10/2024. Applicant completed the Mandated Reporter training on 12/12/2023. Applicant was reminded that Mandated Reporter training requires renewal every two years. Applicant's Preventive Health and Safety and immunization records for measles, pertussis, and influenza are on file.
---------------CONTINUES ON 809 DATED 01/09/2024 PAGE 3----------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: PANAMENO, KATHERINE	FACILITY NUMBER: 434416865
	VISIT DATE: 01/09/2024

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 01/09/2024 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 spouse. Applicant also has five minor children. 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, 01/08/2024, 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.

Applicant will inform Licensing once backyard is ready and to make it on-limits.

Exit interview conducted and report was reviewed with the applicant, Katherine Panameno. Applicant was advised that upon approval of Licensing Program Manager that a license for a large family child care home will be issued.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC809 (FAS) - (06/04)

Page: 3 of 3