434417353-8-18-2023-07-CC-FRAA-CUTKAQ-20230818074420

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417353
Report Date: 08/17/2023
Date Signed: 08/18/2023 07:44:26 AM

Document Has Been Signed on 08/18/2023 07:44 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	GOMEZ, BRENDA		FACILITY NUMBER:	434417353
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/17/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Brenda Gomez		TIME COMPLETED:	10:30 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	Licensing Program Analyst (LPA), Farida Raja met with Applicant, Brenda Gomez, to conduct an announced pre-licensing inspection. LPA was granted access to the home by the Applicant and explained the purpose of today's visit. Per Applicant, the adults that reside in the home are applicant and spouse. Licensee has two minor children residing in the home. The home is a two story with 4 bedrooms and 2.5 bathrooms. Days and hours of operation will be Monday - Friday from 6:00 AM- 6:00 PM. The Applicant completed her Preventative Health and Safety Child Care Training on 03/25/2023 and a copy of the certification is on file. The Applicant's CPR and First Aid certifications are current and expire on 12/10/2023. The Applicant has completed the Mandated Reporter Training for Child Care Workers on 06/14/2023. A copy of current TB test (applicant and spouse), statement declining influenza and MMR vaccinations for the Applicant are on file. LPA observed that the applicant is not associated with her facility. Applicant provided LPA with a copy of the Criminal Background Clearance Transfer Request (LIC 9182) that she submitted to the CCL office. The applicant provided a current lease agreement. Applicant does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). Applicant states that she is planning to obtain daycare insurance once licensed. LPA toured the indoor and outdoor areas of the home with the Applicant during today's inspection. LPA observed barricaded stairs leading to the second level. Off limit areas inside the home: downstairs closet, attached garage and entire second level. LPA observed a fireplace in the on limit living room with a glass cover. The glass cover is not very sturdy and LPA asked applicant to barricade the fireplace by placing a shelf in front or a gate around it to make it inaccessible to children. Off limit areas outside the home: right and left gated side sections. Backyard is fenced and both sides of the home are gated. There are no bodies of water observed. Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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: GOMEZ, BRENDA	FACILITY NUMBER: 434417353
	VISIT DATE: 08/17/2023

NARRATIVE

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Applicant understands that children must be supervised at all times while outdoors. LPA observed age appropriate play structure with artificial grass to absorb falls. LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. Cleaning products are placed in a child locked cabinet under the sink.

Licensee has a working telephone in the home (408-608-8479). LPA inspected home for any health and safety hazards. Areas accessible to children were inspected to ensure that they are clean and orderly. There are sufficient toys, supplies, and equipment for the day care children both indoors/outdoors. Furniture, such as tables, chairs, sleep mats and shelves, are in good condition. The floor is free of tripping hazards with toys placed in bins. The home has central heating/cooling and ventilation for comfort of children.

LPA observed a fully charged fire extinguisher (3A40BC) and working smoke and carbon monoxide detectors. LPA informed the Applicant that fire/disaster drills must be practiced at least once every 6 months and documented. Applicant states that she does not have any weapons/ammunition or pets in the home Cleaning products, toxic agents, medications, and sharp objects were inaccessible to children. LPA has a first aid kit in the closet under the stairs. Sharp objects and knives were observed to be placed in a high kitchen cabinet. LPA reminded applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. Applicant states that she will provide meals and snacks for the day care children. Applicant mentioned that she plans to enroll in a Food Program. LPA reminded the Applicant that any food/liquid products provided by parents will need to be labeled with each child's individual name(s). Drinking water will be provided to children via a water dispenser/disposable cups in the kitchen area.

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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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: GOMEZ, BRENDA	FACILITY NUMBER: 434417353
	VISIT DATE: 08/17/2023

NARRATIVE

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Form of discipline will be to remove the child from the situation and talk to them to help them understand. 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 discussed the requirements of Assembly Bill(AB) 633 with the Applicant. The Applicant understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty and $100 per day violation until corrected is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury.

LPA discussed the safe sleep regulations with 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 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 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. Entrance Checklist was provided to the applicant. Applicant states that she may provide transportation and LPA reminded Licensee that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.

Incidental Medical Services (IMS) policy was discussed. Applicant will wait until facility opens to determine IMS needs. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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: GOMEZ, BRENDA	FACILITY NUMBER: 434417353
	VISIT DATE: 08/17/2023

NARRATIVE

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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.

On this date, 06/20/2023, 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 childcare 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, Brenda Gomez. LPA advised Applicant that a small Family Child Care Home License will be approved upon completion of the following and supervisor approval.

Barricade fireplace and submit picture proof to LPA.
Obtain a Tdap booster and send proof to LPA.
Submit a copy of the signed lease including applicant's (tenant) signatures.
Confirm applicant's association with the facility.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC809 (FAS) - (06/04)

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