434417097-7-13-2023-07-CC-JCRZ-CTPU5D-20230713151635

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417097
Report Date: 07/13/2023
Date Signed: 07/13/2023 03:16:40 PM

Document Has Been Signed on 07/13/2023 03:16 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:	CHAVEZ, VIHANNY		FACILITY NUMBER:	434417097
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/13/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Vihanny Chavez		TIME COMPLETED:	03:45 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	Licensing Program Analyst (LPA) Janette Cruz conducted an announced pre-licensing inspection with Vihanny Chavez, Applicant. The purpose of today's inspection: address the Application for a new Small Family Child Care Home license that the Applicant submitted to the Department on 04/18/2023. Application/Record Review: The Applicant was the only one present in the home during today's inspection. The Applicant states that she, her father, Alvaro Chavez are the only adults residing in the home. Applicant also has a minor sister: (age 13) residing in the home. Days and hours of operation will be Monday to Friday, 7:00AM to 5PM. Applicant has proof of Pediatric CPR and First Aid training with expiration date of 03/11/25 on file. Applicant has updated vaccinations (flu opt-out) and proof of completion of the Mandated Reporter Training for Child Care Workers completed on 01/31/2023 are on file. The Applicant rents the home and a copy of rental agreement verifying control of property is on file. LPA notes that on Applicant's rental agreement, names of the following individuals are listed, whom Applicant stated these individuals are currently not residing in the home but can visit in the home: Herlinda and Rebecca Lazo (Applicant's aunt), Guillermo Jimenez (Applicant's uncle) and Haracio Lazo-Garcia (Applicant's grandfather). Applicant states that she intends to have up to eight children in her day care. The Applicant agreed to give LPA a tour of the home during today’s inspection. LPA observed the home is a two-story home with three bedrooms, two bathrooms, one master bed/bath, living room, family room, kitchen, dining area, attached garage, and backyard, LPA observed that the there is a working telephone in the home (cell #(408-661-6924). LPA observed the home is clean and orderly, with centralized heating and ventilation for safety & comfort.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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: CHAVEZ, VIHANNY	FACILITY NUMBER: 434417097
	VISIT DATE: 07/13/2023

NARRATIVE

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The off-limit areas inside the home are: entire second floor (3 bedrooms, 2 bathrooms, , and on the first floor (kitchen, 1 bedroom, garage). Off-limit areas outside the home - picnic patio area located at the left side of backyard and fenced right side area of backyard. LPA observed no bodies of water. LPA observed a hot tub at the backyard with a safety cover and locked with chains and screws to make it inaccessible to children. Applicant stated that the hot tub is never used and belongs to the landlord of the property. LPA observed a barricaded fireplace and no open face heater units in the home. There are safe and age- appropriate toys, play equipment, and materials for the children. LPA observed the outdoor backyard area of the home is fenced and secure for the children.

LPA observed that the Applicant has designated the living room area where child(ren) can be isolated if exhibiting signs of illness. The home has at least one working smoke and carbon monoxide detector in the home. LPA observed Applicant has one fully charged fire extinguisher (3A40BC) inside the home. Applicant states that there are no firearms or weapons in the home. LPA observed that Applicant has three pet dogs in the home (two Siberian Huskies and one terrier mix), Applicant stated that pet dogs will be kept away from children. All cleaning compounds and medications are adequately stored in locked cabinets and in the garage, inaccessible to children. Applicant was reminded that any poison inside the home must be kept locked. Applicant states that they do not have any baby walkers in the home. Applicant understands that baby walkers are not allowed in the day care. Applicant understands that high chairs are to be used only for eating purposes. Applicant states that no adults smoke and understand that smoking is prohibited in the home.

Kitchen tour: LPA observed the refrigerator and freezer in the home are clean. There are no sharp utensils, cleaning products, lighters/matches, or open bottles of alcohol accessible to children. Applicant understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated.

Bathroom tour: LPA observed the bathroom toilet and faucet are clean, safe, and operable. All shampoos, medication, mouthwash, perfumes, lotions/cosmetics, cleaning products/solvents are inaccessible to the children.

Forms of discipline to be used by Applicant: talking to children. The Applicant understands that children's personal rights should not be violated; including no

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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: CHAVEZ, VIHANNY	FACILITY NUMBER: 434417097
	VISIT DATE: 07/13/2023

NARRATIVE

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corporal punishment, supervision of children, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed with the Applicant during today's inspection.

LPA reviewed with the 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.

This facility will wait to determine for need to implement Incidental Medical Services (IMS). 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.htm

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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with the 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 Applicants 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.

LPA conducted an exit interview with Applicant, Vihanny Chavez, that a small Family Child Care Home license will be approved upon completion of the following:
1. Criminal record clearance and TB test for all adults listed as residents on the lease agreement
2, Approval of Application by LPA's Manager

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC809 (FAS) - (06/04)

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