<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417401
Report Date: 01/25/2024
Date Signed: 01/25/2024 03:19:21 PM

Document Has Been Signed on 01/25/2024 03:19 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:ESQUIVEL, MARIAFACILITY NUMBER:
434417401
ADMINISTRATOR:ESQUIVEL, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 665-2995
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/25/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Esquivel, MariaTIME COMPLETED:
03:30 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 1/25/2024, at 1:40 PM, Licensing Program Analysts (LPAs) Doni Fici and Anna Morales, met with Applicant, Esquivel, Maria and her son for announced pre-licensing inspection. The purpose of today's inspection is to ensure the home is in compliance with Title 22 California Code of Regulations. Upon arrival, LPA was admitted into the home by the Applicant and her son and toured inside and outside during todays inspection.

The Applicant states that adults, over the age of 18, residing in the home are her son. The hours of operation for the family child care home (FCCH) will be Monday - Friday, 7:00AM-5:00PM and the Applicant is planning to offer care for children ages 0 months to fourteen (14) years old. The Applicant has submitted a rental agreement for the home and does currently have liability insurance for the day care.

The 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.

Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2024
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 4
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: ESQUIVEL, MARIA
FACILITY NUMBER: 434417401
VISIT DATE: 01/25/2024
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 fully charged 2A10BC fire extinguisher, functioning smoke detector and carbon monoxide detector. LPA advised completing annual maintenance for the fire extinguisher. The Applicant was provided fire/emergency disaster drill log and was advised drills should be completed every 6 months.

The Applicant states that for discipline of the children, she will use redirection and 1:1 time with the child as needed. LPA advised that if utilized, the recommended duration for "time out" is 1 minute per year of age for the child. The Applicant understands that children's personal rights should not be violated; including no corporal punishment. Children should not be left for extended periods of time in furniture such as a high chair or play pen.

LPA discussed isolation of sick children with the Applicant and she states that if a child were to start feeling sick at her home that she would isolate the child with a napping mat, until the parent/guardian arrives to pick-up. LPA discussed isolation strategies, such as using a baby gate, and utilizing the restroom if the child's symptoms need close restroom access. LPA observed the Applicant has a first-aid kit, and thermometer, available in her home.

LPA additionally discussed supervision of children, unusual incidents (LIC624B), and requirements for additional staff/ adults living in the home. The Applicant states that she does plan to transport children from school to the home. The Applicant additionally understands that she must be home at least 80% of the time FCCH is open.

LPA reviewed small family child care home capacity requirements with the Applicant and provided copy of 102416.5 Staffing Ratio and Capacity from California Code of Regulations.

Continued on Page 4

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: ESQUIVEL, MARIA
FACILITY NUMBER: 434417401
VISIT DATE: 01/25/2024
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
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.

LPA discussed the safe sleep regulations with the Applicant and provided 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.



The 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 and provided to the Applicant, and her son.

LPA advised the Applicant that a large FCCH license will be issued pending manager review and approval.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: ESQUIVEL, MARIA
FACILITY NUMBER: 434417401
VISIT DATE: 01/25/2024
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
LPAs toured inside the home and observed sufficient materials and play equipment for day care children. The front of the home is properly set-up for caring for infants including soft materials covering the floor, toys, and a baby changing table. Off limits inside the home include: garage, Bedroom 1,2, and 3, backyard side door, and shed. LPAs advised if there are changes to the on/off limits of the home to submit an updated facility sketch (LIC999A) to the San Jose Regional Office. There is a working telephone (cell phone) at the FCCH. The Applicant currently has two (2) cribs and nine (9) mats/cots for children's napping. LPA advised that mattress sheets should be changed between infants, if the crib is shared, and infant sheets shall be washed daily.

The Applicant states that all food/formula will be provided by the parents of children enrolled and applicant will also prepare and warm food as needed at her home along with formula for infants. Children will bring water in water bottles if needed. LPA observed kitchen knives properly stored inaccessible to children. LPA advised reviewing storage of materials in kitchen/bathroom cabinets if the restroom is needed by older children in care. Applicant stated there are no firearms in the home.

The Applicant is planning to primarily care for infants and has a baby changing pad, waste bin with a tight fitting lid, and proper storage for diapers and wipes. There is a sink that is easily accessible in the kitchen for use, if needed.

The Applicant states that she is planning to use any outdoor and indoor space for caring for children.








Continued on Page 3
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4