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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700394
Report Date: 10/29/2024
Date Signed: 10/29/2024 12:55:04 PM

Document Has Been Signed on 10/29/2024 12:55 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:TICLLACURI APONTE, WILLIAMFACILITY NUMBER:
435700394
ADMINISTRATOR/
DIRECTOR:		TICCLACURI APONTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 841-2996
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
10/29/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Assistant Providers BONIFAZ, AMALIATIME VISIT/
INSPECTION COMPLETED:
01:15 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 10/29/2024 at 10:30 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Annual / Random Visit. LPA met with the Assistant Providers BONIFAZ, AMALIA and JESSEE, PEIFEN, and explained the nature of the site visit. Present on the visit were 1 infant and 4 preschool children. The home operates from Sunday at 9 pm to Friday at 6 pm.

LPA toured the home to conduct a Health and Safety Inspection with the Applicant. The home is a one-story home. The home is neat and clean with heating and ventilation for safety and comfort.

The ON LIMIT AREAS (accessible to children in care) are the living room, family room, hallway bathroom, Kid's Area Bedroom for napping and the front yard. The front yard is completely fenced and is being used as an outdoor play area. Also, the Licensee is using the nearby park as an outdoor play area and LPA reminded the applicant about outdoor play at the park shall be supervised by the licensee or caregiver. The designated isolation area will be the family Room when a child gets sick during the care.

The OFF-LIMIT AREAS are the Licensee’s bedroom, master bedroom, master bath, kitchen, dining room backyard and the garage which will be inaccessible to children in care by safety fates, closed and or locked doors and or a fence with visual supervision. The designated isolation area for a child who becomes ill while in care is the living room. There are ample age-appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children, and it was observed that there are no toxins or hazardous items accessible today. LPA observed child safety gates on the kitchen.

LPA observed 3 pet dogs at the backyard. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector and working telephone. The fireplace is blocked by bookshelves to prevent access by children. There are no firearms in the home.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: TICLLACURI APONTE, WILLIAM
FACILITY NUMBER: 435700394
VISIT DATE: 10/29/2024
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
The Licensee completed the Health and Safety training completed on 10/23/2023, and CPR (Pediatric) and First Aid completed on 03/5/2023. The Licensee's Assistant Provider - BONIFAZ, AMALIA, CPR (Pediatric) and First Aid completed on 12/12/2021 with validity period of 2 years. The Licensee completed the Mandated Reporter Training Childcare Providers training online on 10/4/2023 and the Licensee' Assistant Provider - BONIFAZ, AMALIA, completed on 6/12/2023. The Licensee and the Licensee's Assistant Provider - BONIFAZ, AMALIA have records of Measles and Pertussis immunization, Influenza declination statement and TB clearance.

Licensee's Applicant Assistant Provider - BONIFAZ, AMALIA 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. 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.



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) 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.

LPA discussed the safe sleep regulations with the Licensee's Applicant Assistant Provider - BONIFAZ, AMALIA 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 the 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.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Report was provided to the Licensee's Applicant Assistant Provider - BONIFAZ, AMALIA.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2