434417317-3-10-2023-07-CC-SCOS-CPHR7C-20230301114606

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417317
Report Date: 03/01/2023
Date Signed: 03/10/2023 01:06:52 PM

Document Has Been Signed on 03/10/2023 01:06 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:	SAYSON, JOSEPHINE		FACILITY NUMBER:	434417317
ADMINISTRATOR:	SAYSON, JOSEPHINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 398-7729
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95132
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	03/01/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Sayson Josephine		TIME COMPLETED:	11:20 AM

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	Pp 1 Licensing Program Analyst (LPA’s) Stephanie Collins conducted an announced, scheduled Pre-Licensing inspection of 1628 Sierraville Ave with Applicant Josephine Li Sayson, Applicant is applying for a licenses to operate a Small Family Child Care Home with a maximum capacity of eight at the address listed above. A copy of the control of property is on file. LPA observed that the home has a fully charged 2A:10BC fire extinguisher. Smoke and Carbon Monoxide Detectors were tested and proved to be functioning. The home’s disaster plan of action was discussed along with the requirement for the home to conduct and document fire and disaster drills at least once every six months. LPA reminded Applicant that smoking is not allowed in Family Child Care Homes and baby walkers cannot be used for children in care. Days and hours of operation will be Monday through Friday 7:00 AM to 6:00 PM. Pediatric and CPR certification expires 07/2024. Applicant has documented proof of immunity against Pertussis. Applicant's Certification of Completion of the AB1207 Mandated Reporter Training expires 4/06/24. Adults who are over the age of 18 and reside in the home are the Applicant and Applicant's Spouse. Both have Clearances for Criminal Record and Child Abuse Index Background Check, and Tuberculosis. Applicant Josephine Lipang Sayson was reminded that all adults 18 and over living or working in the home, 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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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: SAYSON, JOSEPHINE	FACILITY NUMBER: 434417317
	VISIT DATE: 03/01/2023

NARRATIVE

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Pp2
LPA inspected the indoor and outdoor areas of the home. Off limits areas in the home are all Bedrooms, Den, kitchen and garage. The back yard is fenced and will be used for outdoor activity. Off limit area in back yard are side of yard . No open bodies of water observed.
The home is clean and orderly, with heating and ventilation for safety and comfort of children in care. Staircase is barricade with child safety gate to prevent children’s access. Applicant stated that there are no weapons such as firearm stored on the premises. The home does not have any pets. Detergents, cleaning compounds, sharps, medicines, and other items which could pose a danger if readily available to children were stored where they are inaccessible, out of reach of children. LPA reminded Applicant that poisons need to be locked.

Applicant stated that the form of discipline to be used are talking and redirecting the children. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Applicants stated that she understands that the children have personal rights that cannot be waived or abridged regardless of consent or authorization from the child’s authorized representative.
LPA reminded Applicant that if she decides to not carry liability insurance for the Family Day Care, she will have to maintain in children's file an affidavits regarding liability insurance signed by each parent of the children that will be enrolled. LPA reviewed with Applicant the violations that would result in an immediate assessment of civil penalty in the amount of $500.

LPA reviewed with 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

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 platform.
To receive important licensed- related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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: SAYSON, JOSEPHINE	FACILITY NUMBER: 434417317
	VISIT DATE: 03/01/2023

NARRATIVE

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Pp3
LPA also discussed with the Applicant about the continuing requirements, which include but are not limited to the following topics: (1) Separating sick children when they show signs of illness; (2) Supervision of Children; (3) Capacity Options; (4) transportation of children; (5) Procedures for Reporting Suspected Child Abuse and Unusual Incidents/Injuries; (6) Safe Sleep; and (7) Healthy Beverages in Child Care.

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.htm.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep web page 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.

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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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: SAYSON, JOSEPHINE	FACILITY NUMBER: 434417317
	VISIT DATE: 03/01/2023

NARRATIVE

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Pp 4
Based on today's inspection, LPA determined that the home is in compliance with applicable Health & Safety Code and Title 22 Regulations.

Therefore, Applicant was informed that Applicant's file will be submitted to Licensing Management for final approval. Pending the following documents.

1: Proof of immunity- MMR (Measles)

LPA inform Applicant once final approval has been received the Applicant will then be issued a license

Exit interview was conducted, where this report was reviewed with Applicant Josephine Lipang Sayson

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC809 (FAS) - (06/04)

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