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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417279
Report Date: 03/05/2025
Date Signed: 03/10/2025 08:55:46 AM

Document Has Been Signed on 03/10/2025 08:55 AM - 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:VARGAS, PRISCILLAFACILITY NUMBER:
434417279
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: DATE:
03/05/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:48 AM
MET WITH:Priscilla VargasTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA), Syhshyan (Shine) Yu, met with Licensee, Priscilla Vargas, to conduct unannounced inspection for capacity increase at Family Child Care Home (FCCH). Upon arrival, there were 5 children (one is under 2 years old) present which is compliant with current home capacity requirements. Licensee's employee, Marissa Vargas, was also present assisting with the children. Hours of operation are Monday-Friday 7:00AM-5:30PM.

LPA conducted tour of FCCH, both inside and outside with licensee during today's inspection. The home was observed to be clean, orderly, and safe for the day care children. Off limits inside of the home include kitchen, bedroom 1 and 2, and garage. On limits area are living room, kids room, bathroom and side yard. LPA also reviewed staff file record. Her Mandated Reporter Training Certificate expires 11/13/2026 and Pediatric First Aid and CPR certificate expires 10/27/2026.

Licensee states that the San Jose Fire Department had communicated with her regarding her fire inspection and provided her instruction for the fire inspection. Licensee states that she had installed the fire alarm and her fire inspection was conducted and approved by inspector on Jan. 29, 2025. LPA observed the smoke detector and fire alarm on living room, and carbon monoxide and another smoke detector in the hallway. LPA observed 2A10BC fire extinguisher in kitchen closet.

LPA reminded applicant that smoking, baby walkers, and similar items are not allowed in FCCH. The applicant has working telephone.

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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Syhshyan Yu
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: VARGAS, PRISCILLA
FACILITY NUMBER: 434417279
VISIT DATE: 03/05/2025
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Applicant states that she will not administer any medication to the children at this time.

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.

LPA discussed the safe sleep regulations with applicant, Priscilla Vargas 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.


Exit interview conducted and report was reviewed with the Licensee, Priscilla Vargas.
As a result of todays inspection, no deficiencies were cited. Due to printer technical issue, A notice of site visit will be given by email and must remain posted for 30 days.

LPA advised Licensee that increase in capacity will be given upon manager review and final approval.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Syhshyan Yu
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC809 (FAS) - (06/04)
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