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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434418019
Report Date: 11/17/2025
Date Signed: 11/17/2025 04:02:43 PM

Document Has Been Signed on 11/17/2025 04:02 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:VALQUI AGURTO, JENNIFHERFACILITY NUMBER:
434418019
ADMINISTRATOR/
DIRECTOR:		JENNIFHER VALQUI AGURTOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 752-6271
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/17/2025
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:59 AM
MET WITH:Jennifher Valqui AgurtoTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst(LPA) Mandeep Kaur conducted an announced Case Management- Licensee Initiated inspection with Licensee, Jennifher Valqui Agurto. The purpose of today's inspection: in response to a change of location application that the Licensee submitted to the Department on October 17, 2025 for a Large Family Day Care Home. A fire Clearance for Large Family Child Care Home was granted on 11/07/2025.

Licensee stated that Licensee and Licensee’s spouse (A1) are only adults residing in the home with their two minor children. Days and hours of operation are Monday to Friday from 7:30 AM to 5:30 PM. The Licensee completed the Preventative Health and Safety Child Care Training on 11/06/2025 and a copy of the certification is on file. The Licensee has proof of Pediatric CPR and First Aid training completed on 08/11/2024, is on file. A copy of current TB test, flu , MMR, and Tdap vaccinations for the Licensee are on file. Licensee has current completion of the Mandated Reporter Training certificate (AB1207) completed on 09/25/2024 on file. Licensee was advised that Mandated Reporter Training(AB1207) shall be renewed every two years for all staff at the day care home.

Copy of updated facility sketch of the day care home was obtained during today's inspection. The licensee provided proof of control of property. Because the licensee rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the licensee confirms was provided to the property owner/landlord. The licensee obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Mandeep Kaur
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: VALQUI AGURTO, JENNIFHER
FACILITY NUMBER: 434418019
VISIT DATE: 11/17/2025
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Licensee is planning to have liability insurance for the day care home. Licensee understands that if she does not have liability insurance for the day care home, Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) shall be signed by all the parents of the children in care and shall be kept in each child(ren) files. All individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances prior to today's inspection.

LPA toured the indoor and outdoor areas of the facility with Licensee during today's inspection.

LPA observed the home is a single-story home with three (3) bedrooms, a room in the backyard, (2) bathrooms, living room, kitchen with dining area, garage, and backyard. There is a working telephone in the home. The home is clean and orderly, with heating and ventilation for safety & comfort.

LPA observed a barricaded fireplace in the living room. There are no stairs and no wall heaters inside the home. The off-limit areas inside the home are: all 3 Bedrooms with 1 bathroom. Off limit areas outside the home: laundry room , barricaded air conditioner unit (located in the backyard), left and right side sections of the backyard, and attached garage. There is a room outside in the backyard for the children to use during day care hours and inspected by Fire Department on 11/07/2025. LPA observed a separate working smoke and carbon monoxide detector in the outside room and Licensee stated that it was advised by the Fire Department. There are safe and age-appropriate toys, play equipment, and materials for the children in the home. The Licensee has a designated area in the home (side of the hallway in front of the children bathroom) where a child(ren) can be isolated if exhibiting signs of illness. The home has at least 1 working smoke and carbon monoxide detector inside the home. The Licensee has one fully charged fire extinguisher (3A40BC) inside the home. The Licensee stated that she has two pets(dogs) and no weapons/firearms in the home. All cleaning compounds and medications are adequately stored in a cabinet located in laundry room inaccessible to children. LPA reminded Licensee that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. The Licensee has a first aid kit in the home, with sufficient emergency supplies, including a no-touch thermometer.

Kitchen tour: LPA observed the refrigerator and freezer in the home are clean. The Licensee will provide the food for the children in care and understands any bottles served to the children need to be labeled with their names. The Licensee understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated.

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NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Mandeep Kaur
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
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: VALQUI AGURTO, JENNIFHER
FACILITY NUMBER: 434418019
VISIT DATE: 11/17/2025
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Bathroom tour: LPA observed the bathroom toilet and faucet are clean, safe, and operable. The shower is free of any hazards. All shampoos, soap, medication, mouthwash, perfumes, razors, cleaning products, air fresheners, and nail polish/remover are inaccessible to the children.

Outdoor tour: LPA observed the outdoor backyard of the home is fenced, safe, and secure for the children. There are no bodies of water in the backyard. LPA reminded Licensee to dump any water that collects in the containers. Licensee was advised that outdoor play shall be supervised at all times.

Forms of discipline to be used by Licensee: talking to children and redirecting. The Licensee understands that children's personal rights should not be violated; including no corporal punishment, supervision of children, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed with the Licensee during today's inspection.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN22-02-CCP. A Plan of Operation that includes 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.

Licensee 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 safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

as an additional resource. LPA also informed Licensee 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.

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NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Mandeep Kaur
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: VALQUI AGURTO, JENNIFHER
FACILITY NUMBER: 434418019
VISIT DATE: 11/17/2025
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On this date, 10/20/2025, 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.

LPA discussed the Large Family Child Care Home Ratio and Forms/Records to Keep in Large Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Licensee 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-care-licensing/subscribe and select the Child
Care option to receive email communication.

No deficiency issued during today's inspection. Appeal rights were provided.

Exit interview conducted and report was reviewed with Licensee, Jennifher Valqui Agurto. LPA advised Licensee that Large Family Child Care Home license will be issued under the new location effective November 18, 2025.
NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Mandeep Kaur
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
LIC809 (FAS) - (06/04)
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