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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416895
Report Date: 06/12/2024
Date Signed: 06/12/2024 12:22:48 PM

Document Has Been Signed on 06/12/2024 12:22 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:LUGO, ANDREAFACILITY NUMBER:
434416895
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/12/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Andrea LugoTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Samantha Yip and Jennifer Beehler conducted an unannounced pre-licensing inspection. LPAs met with Applicant Andrea Lugo and explained the reason for the inspection. The purpose of this inspection is Applicant is applying for a small Family Child Care Home (FCCH). Present during today's inspection were Applicant and her minor child.

There is a board to post required postings, such as notification of parent's rights. The hours of operation are Monday through Friday 8AM to 6PM. Applicant will be using her cell phone. Applicant understands that if she does not obtain daycare insurance that parents need to sign the Affidavit Regarding Liability Insurance.

LPAs toured the inside and outside of the home with Applicant. The off-limit areas inside are all the bedrooms, all the closets in the hallway, and the bathroom next to the naproom. There is no fireplace or stairs in the home. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible. There are toys and equipment for children. There were no babies 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 on the premise. Applicant plans on using the hallway off of the kitchen to isolate sick children. LPA observed that the window in the bathroom has a crack.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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: LUGO, ANDREA
FACILITY NUMBER: 434416895
VISIT DATE: 06/12/2024
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-------------------continuation of 809 dated 06/12/2024 page 1-------------------

The backyard will be used and is fenced. The off-limit areas outside are laundry room, the shed, detached garage, area behind the detached garage, and the left side of the yard. There is a playstructure, which is anchored to the ground. There is a see-saw that was not anchored to the ground. Applicant understands that any climbing structure needs to be anchored to the ground. LPA discussed with Applicant that the area behind the detached garage needs to be inaccessible to children. There were no bodies of water observed during today's inspection. LPA observed that a portion of the detached garage was converted and that the laundry room is enclosed. LPA discussed with Applicant that any alterations to the home or new add-ons need to have permit.

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. There are playyards. LPA discussed with Applicant that the mattress needs to be firmed.

Applicant stated that all meals and snacks will be prepared and brought from home. She understands that all containers brought from home need to have the child's name on it. Applicant does not plan on transporting children, but understands that children cannot be left alone and unattended in parked vehicles. The form of discipline Applicants plan on using is talking to the children. Applicant understands that children's personal rights cannot be violated, such as 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) 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.
---------------------continuation of 809 dated 06/12/2024 page 1------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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: LUGO, ANDREA
FACILITY NUMBER: 434416895
VISIT DATE: 06/12/2024
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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 03/2026. Applicant completed the Mandated Reporter training on 01/24/2024 and understands that it needs to be renewed every two years. Applicant's immunization records for measles, pertussis, and flu are on file; along with her certificate for Preventive Health and Safety.

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).

Applicant is the only adult 18 and over living in the home. Applicant also has three minor children. Applicant has cleared criminal record, child abuse index, and TB. 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, 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.
-----------------------continues on 809 dated 06/12/2024 page 4-------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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: LUGO, ANDREA
FACILITY NUMBER: 434416895
VISIT DATE: 06/12/2024
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Licensee understands that she cannot be absent more than 20 percent of her daycare hours each day.

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.

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, LIC 999A and financial statement was obtained during today's inspection.

Exit interview conducted and report was reviewed with the applicant, Andrea Lugo. Applicant was informed that upon review and approval of Licensing Program Manager a license for a small FCCH will be granted and issued upon completion of the following:
- see-saw is either anchored or removed
- mattress for playyards are firm and there is no bumps in the mattress
- review of laundry room and portion of the garage that was converted
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC809 (FAS) - (06/04)
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