434417074-3-10-2023-07-CC-SCOS-CPSNUH-20230310094618

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417074
Report Date: 02/21/2023
Date Signed: 03/10/2023 01:05:21 PM

Document Has Been Signed on 03/10/2023 01:05 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	HERNANDEZ, MARIADEL		FACILITY NUMBER:	434417074
ADMINISTRATOR:	MARIADEL HERNANDEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 332-7065
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	02/21/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Mariadel Carmen Hernandez		TIME COMPLETED:	12:10 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	Page 1 Licensing Program Analyst (LPA) Stephanie Collins met with Applicant Mariadel Carmen Hernandez and her daughter Daniela Hernandez and explained the purpose of today's inspection. Mariadel Carmen Hernandez has submitted an application for a small Family Child Care Home (FCCH) with a capacity of 6-8 children. Days and hours of operation are Monday through Friday from 07:30 AM – 5:30 PM. There are five (5) adults residing in the home: Applicants' Husband (Torres Hernandez) Daughter (Daniela Hernandez) and two (2) sons (Alexis Hernandez and Leonardo Hernandez . A review of records show that all individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who comes in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period. Applicants Pediatric CPR and First Aid expires on 7/2024. Applicant has records showing proof of immunity against Measles and Pertussis. Licensee's AB1207 Mandated Reporter Training Certificate expires on 11/29/2023.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HERNANDEZ, MARIADEL	FACILITY NUMBER: 434417074
	VISIT DATE: 02/21/2023

NARRATIVE

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LPA reviewed required files documents and posting to have available during an inspection. LIC 311E document (Records to be maintained at the facility) was made available and discussed with applicant .

LPA inspected the indoor and outdoor areas of the home. Smoke and Carbon monoxide detectors were tested and proved to be functioning. Fire and disaster drill log were discussed (Once every six months). LPA observed a fully charged fire extinguisher. Medication, cleaning products and similar items that can pose a danger to children if readily accessible are stored inaccessible to children. Licensee states that there are no weapons in the home.

This is a single-story home : Off limits areas in the home are all bedrooms launder room, kitchen and detectable garage/storage. The home has an outdoor build-in Bar B Q area that is off limits to children in care, the entrance is blocked by a child security gate to prevent access by children. Outdoor activity will be supervised at all times. Backyard is fully fenced in. There were no bodies of water observed.

The home is clean and orderly with heating and ventilation for safety and comfort of children in care. Licensee has one small sized pet dog that is accessible to the day care children. Per Licensee, the dog is current with vaccination.

Licensee stated she does not transport children.

LPA reviewed with Licensee the maximum capacity for a Small Family Child Care Home with chart.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HERNANDEZ, MARIADEL	FACILITY NUMBER: 434417074
	VISIT DATE: 02/21/2023

NARRATIVE

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Safe sleep information was reviewed with applicant.

LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

Applicants was informed that applicants request for a Small Family Child Care Home will be submitted to Licensing Management for final approval. Once final approval has been received a license to operate a Small Family Child Care Home at this address will be issued.

Exit Interview was conducted, where this report, was discussed and reviewed with Licensee Mariadel Hernandez and Daniela Hernandez . A copy of this report was given to Licensee.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

LIC809 (FAS) - (06/04)

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