434417379-8-29-2024-07-CC-AMOS-D8LUZF-20240829160126

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417379
Report Date: 08/29/2024
Date Signed: 08/29/2024 04:01:31 PM

Document Has Been Signed on 08/29/2024 04:01 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	AZTLAN, EILEEN		FACILITY NUMBER:	434417379
ADMINISTRATOR/ DIRECTOR:	AZTLAN, EILEEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 512-8584
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	08/29/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Eileen Aztlan		TIME VISIT/ INSPECTION COMPLETED:	11:45 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)Anna Morales conducted an Announced PRE LICENSING inspection and was greeted by Applicant Eileen Aztlan. Applicant stated that the only adults who are residing at the facility are her daughter and her son. All have been fingerprint cleared and associated. Hours of operation will be Monday- Sunday, 12am to 11:00pm. There is a working telephone, (408)512-8584 available. Fire Clearance was granted on 3/4/24 for a LARGE FAMILY DAY CARE. The Applicant completed the Preventative Health and Safety Child Care Training on 9/26/23. Pediatric CPR and First Aid training expires on 11/9/2025. A copy of current TB test, flu, MMR, and Tdap vaccinations for the Applicant are on file. Mandated Reporter Training for Child Care Workers expires on 12/3/2025. The Applicant rents the home and copy of the lease agreement verifying control of property is on file. The Applicant does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) until she obtains insurance coverage. LPA toured the indoor and outdoor of the facility during today's inspection. The facility is a two story home with two bedrooms and bathroom downstairs and upstairs there are three bedrooms and two bathrooms. Applicant stated that the entire upstairs are off limits to the children. LPA observed a barricade in front of the stair case. Downstairs is the kitchen, living room, Bedroom Number One( closest to the front door) will be accessible for children's use. Bedroom Number Two ( end of the hallway)will not be accessible to the children. LPA observed a covered gas fire place in the living room. The home is clean and orderly, with heating and ventilation for safety & comfort.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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 3

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: AZTLAN, EILEEN	FACILITY NUMBER: 434417379
	VISIT DATE: 08/29/2024

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
26
27
28
29
30
31
32

LPA observed the backyard. There are two sheds in the backyard which will not be accessible to the children. The left side of the house will not be accessible to the children as well. There is a secured play structure( climbing structure and swings). LPA advised Applicant to place an item below the climbing structure that will observe falls. No bodies of water were observed. LPA observed a fenced backyard. Applicant has two dogs who will not be interacting with the day care children. LPA observed a fully charged fire extinguisher (2A10BC), -smoke and carbon monoxide detector.

Forms of discipline used by Applicant: talking to children/redirection. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. LPA reminded Applicant that smoking, baby walkers, Jumpers, bouncers and similar items are not allowed in Family Child Care Homes.

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 informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.
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 discussed the requirements of 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 with the Applicant and advised her of the assessment of an immediate $500 civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: AZTLAN, EILEEN	FACILITY NUMBER: 434417379
	VISIT DATE: 08/29/2024

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
26
27
28
29
30
31
32

LPA provided and 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-and-resources/safe-sleep as an additional resource. LPAs 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

APPLICANT STATED THAT SHE WILL NOT PROVIDE IMS SERVICES (Incidental Medical Services) and the 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)/ (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

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.
Applicant was informed of the MyChildCarePlan.org website; a
consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
Exit interview conducted and report was reviewed with the Applicant.
LPA informed the APPLICANT the following:
1. Submit a photo of playground with absorbent material that will observe a fall.
2. Submit a statement that the pit in the backyard will be put in an area inaccessible to children's use during day care hours.
3. Licensure pending on final review from Management.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC809 (FAS) - (06/04)

Page: 3 of 3