434417125-8-2-2023-07-CC-MSMS-CUBUNE-20230802154349

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417125
Report Date: 08/02/2023
Date Signed: 08/02/2023 03:44:13 PM

Document Has Been Signed on 08/02/2023 03:44 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:	VARGAS CAMACHO, MARIA		FACILITY NUMBER:	434417125
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/02/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Maria Vargas Camacho		TIME COMPLETED:	04:00 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 Analysts (LPAs) Mel Matos and Jessica Bongardt met with Maria Vargas Camacho, Applicant, to conduct an announced prelicensing inspection at 526 East Evelyn Avenue, Sunnyvale CA 94086. LPAs note that Applicant resides in a duplex and her unit (front unit) faces East Evelyn Avenue. LPA were granted access to the home by the Applicant. Applicant was the only adult present in the home during today's inspection. The Applicant and Applicant's fiancé (Jonathan Correa Sanchez) are the only adults residing in the home. There are no minor children residing in the home. Days and hours of operation will be Monday - Friday from 8:00 AM to 5:30 PM. Applicant completed her Preventative Health and Safety Training on 04/28/2023 and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 04/19/2025. Applicant completed the Mandated Reporter Training for Child Care Workers on 06/11/2023 and a copy of the certification is on file. A copy of current TB test, Mmr, Tdap, and flu (opt out)vaccinations for the Applicant are on file. Because the Applicant rents/leases the home, proof of landlord notification is required. LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the Applicant confirms was provided to the property owner/landlord. Applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Copies of both documents are on file. Applicant provided proof of control of property to the Department prior to today’s inspection and a copy of the lease agreement is on file. Applicant does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) to all enrolling families unless she obtains liability insurance in the future. LPAs toured the indoor and outdoor areas of the home with the Applicant during today's inspection. There are no stairs and wall heater units inside the home. Off limit areas inside the home: master bedroom, kitchen, barricaded fireplace unit (located in the living room area), and basement. The space/gap between the concrete step and gate area leading to the outdoor basement entrance needs to be sealed off to make the area completely off limits. Off limit areas outside the home: right side area of the home, front yard, and left side driveway area. Note: Padding needs to be installed underneath and surrounding the two slides in the play structure in the backyard. The home is clean, orderly, including heating and ventilation, for safety & comfort. The Applicant has a valid phone in the home (#669-290-5077). There is sufficient toys, supplies, and equipment for the day care children both indoors/outdoors.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

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: VARGAS CAMACHO, MARIA	FACILITY NUMBER: 434417125
	VISIT DATE: 08/02/2023

NARRATIVE

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LPA observed a fully charged fire extinguisher (3A40BC), working combo smoke & carbon monoxide detectors, no bodies of water, and fenced backyard. Applicant states that she does not have any pets or weapons/ammunition in the home.

Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. Applicant states that any poisons are stored in the locked downstairs basement. LPA reminded Applicant that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. Applicant states that she will not administer any medication to the children at this time. Applicant states that a child will be isolated in the one of the bedrooms if necessary due to illness or communicable disease. Applicant has a First Aid kit with a touchless thermometer in the home.

Forms of discipline to be used by Applicant: talking to children & redirection. Applicant understands that children's personal rights should not be violated; including no corporal punishment. isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed the Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

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.

Maria Vargas Camacho, 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.

LPA reviewed with Maria Vargas Camacho, 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. Prelicensing Entrance Checklist – Family Child Care Homes (LIC 9280) was provided to the Applicant.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

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: VARGAS CAMACHO, MARIA	FACILITY NUMBER: 434417125
	VISIT DATE: 08/02/2023

NARRATIVE

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LPA discussed the safe sleep regulations with Maria Vargas Camacho, 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, 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.

On this date, 07/05/2023, 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.

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-carelicensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicant, Maria Vargas Camacho. LPA advised the Applicant that a small Family Child Care Home license will be approved upon completion of the following:

1) Updated Facility sketch reflecting the correct off limit and day care use space has been submitted.
2) Padding has been installed underneath and surrounding the two slides in the play structure in the backyard.
3) The space/gap between the concrete step and gate area leading to the outdoor basement entrance needs to be sealed off to make the area off limits.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC809 (FAS) - (06/04)

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