434417353-9-19-2024-07-CC-FRAA-D99W3F-20240919165550

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417353
Report Date: 09/19/2024
Date Signed: 09/19/2024 04:55:55 PM

Document Has Been Signed on 09/19/2024 04:55 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:	GOMEZ, BRENDA		FACILITY NUMBER:	434417353
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 3	CENSUS: 2	DATE:	09/19/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:23 AM
MET WITH:	Brenda Gomez		TIME VISIT/ INSPECTION COMPLETED:	12:10 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	On 09/19/2024 at 10:23am, Licensing Program Analyst (LPA) Farida Raja conducted an unannounced Case Management Inspection in response to a request to increase the capacity from 8 to 14 children. LPA met with Licensee, Brenda Gomez, and explained the purpose of today's visit. Present in the home were licensee and two children including one infant and one preschool child which is compliant with current home capacity requirements. Per Licensee, there are two adults residing in the home: licensee and spouse. All adults have criminal record and tuberculosis clearances. Licensee has two minor children residing in the home. Licensee has been licensed as a small Family Child Care Home License since 08/21/2023 and thus has met the minimum one year experience requirement. Fire clearance was granted on 09/11/2024. Licensee states that the daycare is open Monday to Friday from 5:30 AM to 8:00 PM. Licensee provided an updated Application for a Family Child Home License (LIC 279) during today's inspection. Licensee has completed the Preventative Health and Safety Training including Nutrition and Lead Poisoning Prevention and a copy of the certification is on file. Licensee's CPR and First Aid certifications are current and expire on 12/10/2025. Licensee’s Mandated Reporter Training expires on 06/14/2025. LPA discussed and provided Licensee with a copy of the ratio and capacity chart. LPA obtained a copy of children's roster. Applicant leases the house and a Property Owner/Landlord Consent form (LIC 9149) and is on file. Licensee has liability insurance and LPA observed a a current policy verifying valid coverage. LPA inspected the indoor and outdoor areas of the home. The home is a two storey with 4 bedrooms and 2.5 baths. LPA observed a fully charged 3A40BC fire extinguisher in the kitchen, functioning smoke and carbon monoxide detectors and barricaded stairs to the upper level. LPA reminded licensee that the fire extinguisher needs to be serviced once every 12 months. LPA observed a fire place in the on limit living room that has a glass cover. Last fire drill was conducted on 08/22/2024. Off limit areas inside the home: downstairs closet, attached garage and entire second level. Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

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: 09/19/2024

NARRATIVE

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Cleaning products, sharp objects, and other similar items are stored inaccessible to children in high kitchen cabinets. Licensee states that there are no weapons in the home. LPA observed one pet dog and Licensee stated that she is dog sitting temporarily and does not have any pets of her own. Backyard is fenced and both side yards of the home are gated. LPA observed sufficient toys, supplies and play equipment for the children both indoors and 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 bathroom sink.

The outdoor space and play equipment were observed to be age appropriate and free of hazards. Licensee stated that children are not taken outdoors at this time as they are completing some yard work. LPA observed several dangling cables on the wall near the on limit outdoor area and a barbecue grill. LPA advised Licensee to make cables and grill inaccessible to children. LPA also observed several broken tiles outdoors and advised licensee to remove any tripping hazards and make outdoor area safe prior to allowing access to children. Licensee stated that she will remove or make cables inaccessible, move the grill to the side yard and fix all tripping hazards before children are taken outdoors. Shade is provided by canopy and trees. There were no bodies of water observed. Licensee has 2 play pens and 5 nap mats to be used by children during nap time. Licensee states that she provides breakfast, lunch and snacks to the children in care. Drinking water is available through the water dispenser in the kitchen area.

LPA reviewed Licensee's file and it was complete with required forms. LPA reviewed 15 minute nap check log for one infant in care. Licensee 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 discussed the safe sleep regulations with licensee, 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.

Continued on Page 3

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

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: 09/19/2024

NARRATIVE

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LPA also informed licensee 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.

Supervision of children was discussed with Licensee, and she understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. LPA discussed the requirement for Licensee to be present at the facility 80 percent of the hours the facility is in operation and that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. Licensee understands the capacity options and she understands that she cannot have more than 14 children in the home at any time and a qualified assistant must be present. Licensee understands in absence of a helper the license capacity is reduced to 8 and ratio (age of the children) must be observed.

Licensee stated that she does not transport any day care children. LPA reminded Licensee that if she decides to transport children, children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

As a result of today's inspection, there were no deficiencies cited.

Exit interview conducted and report was reviewed with Licensee, Brenda Gomez. LPA advised Licensee that a Large Family Child Care Home license will be issued upon manager review and approval.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC809 (FAS) - (06/04)

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