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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417617
Report Date: 02/14/2023
Date Signed: 02/14/2023 11:28:29 AM

Document Has Been Signed on 02/14/2023 11:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:VALDES, MARIAFACILITY NUMBER:
434417617
ADMINISTRATOR:MARIA VALDESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 658-3059
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
02/14/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Maria ValdesTIME COMPLETED:
11:29 AM
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Licensing Program Analyst (LPA) Teodoro Trujillo met with Applicant, Maria Valdes, to conduct an announced prelicensing inspection. LPA was granted access to the home by the Applicant. No children were present in the home during today's inspection. The Applicant, her spouse, Manuel Cristancho and adult daughter Ana are the adults residing in the home. There are no minor children residing in the home.

Days and hours of operation will be Monday - Friday from 8:30 AM to 5:30 PM. Applicant completed her Preventative Health and Safety Child Care Training on 01/15/2023 and a copy of the certification is on file. Applicants CPR and First Aid certifications are current and expire on 11/21/2024. Copies of both certifications are on file. Applicant completed the Mandated Reporter Training for Child Care Workers on 09/16/2021 and a copy of the certification is on file. A copy of current TB test, flu, Mmr, and Tdap vaccinations for the Applicant are on file. Applicant owns the home and a copy verifying control of property is on file. Applicant understands that she cannot care of more than 14 children at any time. Applicant does not have liability insurance 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 the Applicant during today's inspection. The Applicant's home is one story and LPA observed no stairs during today's inspection. There are no wall heater units in the home. Applicant states that she will operate the day care in the following areas: Living room, bedroom 1, kitchen, and one bathroom. Off limit area inside the home: barricaded gas fireplace unit which gas has been turned off, two bedrooms and hallway closet. Off limit areas outside the home: detached garage, and left side of the backyard .

The home is clean, orderly, (including heating/air conditioning), and ventilation for safety & comfort. There is sufficient toys, supplies, and equipment for the day care children both indoors/outdoors. LPA observed a fully charged fire extinguisher
(2A10BC) and working combo smoke and carbon monoxide detectors, fenced backyard, and no bodies of water. Applicant states that she do not have any weapons/ammunition in the home.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2023
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: VALDES, MARIA
FACILITY NUMBER: 434417617
VISIT DATE: 02/14/2023
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Maria, 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.

LPA provided and reviewed 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. LPA also discussed the importance of maintaining records for any person/assistant providing care to the children and children in the home under 10 years of age. LPA informed the applicant of the following: A 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. 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
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: VALDES, MARIA
FACILITY NUMBER: 434417617
VISIT DATE: 02/14/2023
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APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:
Incidental Medical Services (IMS) 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

PIN 22-02-CCP - Best Practices Related to the Provision of Incidental Medical Services in Child Care Center and Family Care Homes was provided to Applicant.

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 provided the applicant the Department website: www.ccld.ca.gov

Exit interview conducted and report was reviewed with the Applicant, Maria Valdes, and LPA advised her that a small Family Child Care Home License(FCCH) is pending approval by Licensing Program Manager (LPM).

This report has been amended on 2/21/2023 due to LPA oversight stating approval of small Family Child Care Home License for a change of location. The correction is, License is pending approval for a LARGE FCCH License by LPM.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
LIC809 (FAS) - (06/04)
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