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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417294
Report Date: 10/19/2022
Date Signed: 10/19/2022 08:07:42 PM

Document Has Been Signed on 10/19/2022 08:07 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:GONZALEZ, MARINAFACILITY NUMBER:
434417294
ADMINISTRATOR:GONZALEZ, MARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
4087240069
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/19/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marina Gonzalez TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA), Stephanie Collins, conducted an announced Pre-inspection for a Family Child Care Home (FCCH). LPA met with Applicant Marina Gonzalez and informed her the purpose of the visit. Maria is applying for
A large day care license, Maria was previously licensed for a small day care licenses and meets the requirements for a large day care license.
LPA arrived at the home at 9:00 A M. Notification of Parents’ Right Poster, Children's Personal Rights, Child Care License, LIC 610 Emergency Disaster Form (1and 2), were observed. FCCH operating days and hours will be Monday-Friday 06:00 AM to 05:30 PM.
LPA reviewed with Applicant Marina Gonzalez 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.
The adults who resided in the home are the licensee her cousin (Pedro Villalobos) and their four children. 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 inspected the home inside and out with Applicant Marina Gonzalez. The toys and play equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Bathroom for children to use were observed to be in operating conditions. There is a designated area in the living room sick children can utilize if isolation is required. Applicant states there are no weapons or ammunition's on the premises. The home maintains telephone service. Applicant is aware a fire drill is required to be conducted once every six months and time and date shall be documented. Applicant is aware smoking is prohibited on the premises of a family child care home, A baby walker shall not be allowed on the premises of the family child care home.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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: GONZALEZ, MARINA
FACILITY NUMBER: 434417294
VISIT DATE: 10/19/2022
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Off limits areas in the home are all bedroom, storage rooms and garage. There is a fireplace in the living room that is barricaded to prevent access by children. The home has a functioning smoke detector and fire extinguisher that meets standards established by the state fire marshal as well as a fire pull station. Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible.
Backyard is enclosed and fully fenced in . LPA observed play equipment were maintained in a good condition, free of hazards. There were no bodies of water observed.

Incidental Medical Services –Incidental Medical Services –was discussed children in care who requires IMS, Applicant with submit to the Community Care Licensing office an individual IMS Plan. 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

LPA discussed the safe sleep regulations with Marina Gonzalez 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 licensee [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

Marina Gonzalez is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: ccld.ca.gov] to access resources for Providers, Regulations etc.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Marina Gonzalez
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC809 (FAS) - (06/04)
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