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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417461
Report Date: 02/11/2025
Date Signed: 02/11/2025 02:59:24 PM

Document Has Been Signed on 02/11/2025 02:59 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:JIMENEZ AMEZOLA, GUILLERMOFACILITY NUMBER:
434417461
ADMINISTRATOR/
DIRECTOR:		GUILLERMO JIMENEZ AMEZOLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 278-5143
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
02/11/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Guillermo AmezolaTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Anna Morales conducted an unannounced pre-licensing inspection, and was greeted by Applicant Guillermo Jimenez Amezola. Days and hours of operation will be Monday to Sunday 12am to 11:00PM. The Applicant informed LPA that he and another adult are the two adults who resides at the house.
The Applicant completed the Preventative Health Practices with lead/nutrition course in 12/24. Pediatric First Aid & CPR expires on 4/22/25, and Mandated Reporter Training expires 2/16/25.
Licensee was reminded that all adults 18 and over living or working in the home, 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.

The Applicant is renting the property and a copy of lease agreement is on file.The Applicant has not obtained a signed Property Owner/ Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with maximum capacity of 6 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License(LIC279)must be submitted with a change of capacity fee of $25.00, to increase the capacity and provide care to 8 to children.



The Applicant states that he will have liability insurance and understands that if liability insurance is not carried, he will have the parents complete the Affidavit Regarding Liability Insurance(LIC 9182) The Applicant states that he will transport children, and understands that children cannot be left in parked vehicles unattended at any time.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: JIMENEZ AMEZOLA, GUILLERMO
FACILITY NUMBER: 434417461
VISIT DATE: 02/11/2025
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The facility is a single story home. LPA observed the main area of the home to be used for the day care will be in the living room, and two bedrooms/activity rooms. There is a kitchen with a small dining area and two bathrooms accessible to the children. LPA observed a charged Fire Extinguisher and working smoke/carbon detectors. The Applicant has a designated area in the home where a child(ren) can be isolated if exhibiting signs of illness. LPA observed the home is clean and orderly Off limit areas inside the home: the master bedroom. laundry area and one closet, attached driveway and storage shed in the backyard. There is a fence surrounding the backyard. LPA observed age appropriate toys and a covered patio. No bodies of water were observed. Due to lay out of the porch, supervision of children have to be supervised at all times.

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.
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.
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.

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
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: JIMENEZ AMEZOLA, GUILLERMO
FACILITY NUMBER: 434417461
VISIT DATE: 02/11/2025
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APPLICANT STATED THAT HE 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.
On this date, 2/11/24, 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.

Exit interview conducted and report was reviewed with Applicant,Guillermo Jimenez Amezola . LPA advised Applicant that Large Family Child Care Home license will be issued upon completion of the following:

1. Licensing Program Manager (LPM) review and approval.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC809 (FAS) - (06/04)
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