434416894-6-18-2024-07-CC-SYIP-D6CTG2-20240618144221

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416894
Report Date: 06/18/2024
Date Signed: 06/18/2024 02:42:30 PM

Document Has Been Signed on 06/18/2024 02:42 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:	SAIGO, RIBEKA		FACILITY NUMBER:	434416894
ADMINISTRATOR/ DIRECTOR:	RIBEKA, SAIGO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 506-9205
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95117
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 0	DATE:	06/18/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Ribeka Saigo		TIME VISIT/ INSPECTION COMPLETED:	10:40 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 Ribeka Saigo and explained the reason for the inspection. The purpose of this inspection is Applicant applied for a change of location. Applicant is currently license at 218 N Cypress Avenue, Santa Clara 95050 (facility # 434412634). A fire clearance was granted on 05/14/2024. Licensee will be using her cell phone. The hours of operation are Monday through Friday 9AM to 5PM. Applicant will post required postings, such as parent's rights, by the front door. Applicant understands that if she does not have daycare insurance that parents need to sign the Affidavit Regarding Liability Insurance. LPA toured the inside and outside of the home with Applicant. The off-limit areas inside of the home are Bedroom 1, Bedroom 2, closet in the hallway, kitchen, and garage. There is a fireplace, which is barricaded. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible. LPA reminded Applicant that any cleaning supplies need to be locked and any razors needs to be inaccessible. 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 bedroom 3 to isolate any sick children. Applicant will use the backyard and is fenced. The off-limit areas outside are the laundry room, the grass area, and the left and right side of the backyard. LPA discussed with Applicant to check for any cracks in equipment and any water in wading pools need to be dumped out after use. There were no bodies of water observed during today's inspection. -------------------continues on 809 dated 06/18/2024 page 2-----------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

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

FACILITY NAME: SAIGO, RIBEKA	FACILITY NUMBER: 434416894
	VISIT DATE: 06/18/2024

NARRATIVE

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------------------continuation of 809 dated 06/18/2024 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-andresources/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.

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 not plan on transporting children, but understands that children cannot be left alone and unattended in parked vehicles.

Applicant will only be providing snacks to children and understands that any containers brought from home need to have the child's name on it.

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.

---------------------continues on 809 dated 06/18/2024 page 3--------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

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: SAIGO, RIBEKA	FACILITY NUMBER: 434416894
	VISIT DATE: 06/18/2024

NARRATIVE

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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).

Applicant has a valid CPR/1st Aid, which expires on 12/16/2025. Applicant
completed the Mandated Reporter training on 08/27/2023 and was reminded training requires renewal every two years. Applicant's immunization records for measles and pertussis are on file; along with her Preventive Health and Safety training.

The adults 18 and over living in the home are Applicant, her spouse, and her adult child. Applicant's three minor grandchildren also live in the home. Applicant was reminded that her grandchild will count in her ratio until they turn 10 and are present in the home during her daycare hours. All adults have cleared criminal record, child abuse index, or exemption, 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.

--------------------continues on 809 dated 06/18/2024 page 4------------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: SAIGO, RIBEKA	FACILITY NUMBER: 434416894
	VISIT DATE: 06/18/2024

NARRATIVE

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-----------------continuation of 809 dated 06/18/2024 page 3-------------------

On this date, 06/10/2024, 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 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.

Licensee stated that she understands that she needs to be living in the home.

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

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC809 (FAS) - (06/04)

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