434417387-12-19-2023-07-CC-FRAA-CYP23Z-20231219160309

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417387
Report Date: 12/19/2023
Date Signed: 12/19/2023 04:03:16 PM

Document Has Been Signed on 12/19/2023 04:03 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:	CERVANTES, DIANA		FACILITY NUMBER:	434417387
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	12/19/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Diana Cervantes		TIME COMPLETED:	02:30 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 12/19/2023 at 11:50am, Licensing Program Analyst (LPA), Farida Raja met with Applicant, Diana Cervantes, to conduct an announced pre-licensing inspection. LPA was granted access to the home by applicant and explained the purpose of today's visit. Per applicant, the adults that reside in the home are applicant, brother, Wuilmer Cervantes, sister-in-law, Yaritza Orejel Gutierrez and friend/co-tenant, Yvonne Telles. Licensee has no minor children residing in the home. The home is single story with 3 bedrooms and 2 bathrooms. The garage of the home is converted into an Accessory Dwelling Unit (ADU) and has a separate entrance to the left of the main entrance. The ADU has one bedroom, one bathroom and one kitchen. Applicant stated that they do not have access to the ADU from the home and will be off limit to the daycare children. The ADU is occupied by co-tenant and applicant stated that she does not have access to it. Days and hours of operation will be Monday - Friday from 6:00 AM- 6:00 PM. Applicant completed her Preventative Health and Safety Child Care Training on 12/09/2023 and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 08/07/2025. Applicant completed the Mandated Reporter Training for Child Care Workers on 08/10/2022. A copy of current TB test (applicant, brother, sister-in-law and friend/co-tenant), MMR, Tdap and statement declining influenza vaccination for the applicant are on file. 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). LPA toured the indoor and outdoor areas of the home with applicant during today's inspection. Off limit areas inside the home: two bedrooms, master bedroom and master bathroom. LPA inspected home for any health and safety hazards. Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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: CERVANTES, DIANA	FACILITY NUMBER: 434417387
	VISIT DATE: 12/19/2023

NARRATIVE

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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. The floor is free of tripping hazards with toys placed in shelves. The home has central heating, fans for cooling and ventilation for comfort of children. There are no fireplaces in the home. LPA observed a barricaded wall heater in the off limit area of the home. Cabinets in the kitchen were observed to be child locked and LPA observed knives and sharps placed in high kitchen cabinet's. Cleaning products are placed in a child locked cabinet under the kitchen sink. LPA observed the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. Off limit areas outside the home: gated and child locked washer and dryer area, child locked water heater area and entire left side barricaded section which includes two storage sheds. LPA observed portions of the off limit area barricaded with plywood to prevent access to them. Backyard is fenced and gated on the right side. LPA observed portions of the fence are reinforced with plywood. Applicant understands that children must be supervised at all times while outdoors. There are no bodies of water observed. Shade is provided outdoors by a wooden canopy and trees.

Licensee has a working telephone in the home (408-724-0807). LPA observed a fully charged fire extinguisher (2A10BC) in the hallway leading to the bedrooms and a working smoke and carbon monoxide detector. 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 in the home. Applicant has two dogs and one cat and all pets have current vaccinations. Applicant has a first aid kit and emergency bag placed on top of the refrigerator. 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. 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 individual water bottles and refilled using store bought water gallons.

LPA observed an area near the front entrance for required posted materials. 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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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: CERVANTES, DIANA	FACILITY NUMBER: 434417387
	VISIT DATE: 12/19/2023

NARRATIVE

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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.

Form of discipline will be to have child sit down, explain to them what they did wrong, have them reflect on it and teach them to apologize. 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 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.

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 will provide transportation if needed and LPA reminded applicant 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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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: CERVANTES, DIANA	FACILITY NUMBER: 434417387
	VISIT DATE: 12/19/2023

NARRATIVE

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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. 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, 11/06/2023, 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 address. 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, Diana Cervantes. LPA advised Applicant that a small Family Child Care Home License will be approved upon supervisor approval.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC809 (FAS) - (06/04)

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