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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416841
Report Date: 11/07/2023
Date Signed: 11/07/2023 03:46:32 PM

Document Has Been Signed on 11/07/2023 03:46 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:RUBALCABA PEREZ, MAGDAFACILITY NUMBER:
444416841
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/07/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:Magda "Nallely" Ruvalcaba PerezTIME COMPLETED:
03:56 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
Licensing Program Analyst (LPA), Cortney Nelson, met with Applicant, Magda "Nallely" Ruvalcaba Perez, 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 toured inside and outside during todays inspection.

The Applicant states that adults over the age of 18 living in the home are herself and her spouse (Fernando). The Applicant has two minor children living in the home. LPA advised that children living in the home will be included in the home ratio and capacity until they turn 10 years of age. The primary hours of operation for the family child care home (FCCH) will be Monday - Friday, 6:30AM-6:00PM and the Applicant is planning to offer care for children ages 3 months to 10 years old. The Applicant has submitted a mortgage statement for the home and does not currently have liability insurance for the day care. LPA advised applicant to provide parents with Affidavit Regarding Liability Insurance (LIC282) upon registration until liability insurance is purchased in the future.

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.

LPA toured inside the home and advised that the garage is not allowed for day care use, unless permitted to become a habitable space. The Applicant states that she will submit an updated facility sketch (LIC999A) to reflect changes for the on/off-limits areas of the home. Off limits inside the home currently includes the entire second story. There is a working telephone (cell phone) at the FCCH. The Applicant currently has one pack n play and is planning to purchase eight cots and sheets for children's napping. LPA advised that mattress sheets should be changed between infants, if the pack n play is shared. The stairs to the second floor are properly barricaded with a baby gate. LPA advised that a follow-up visit will be made to review the home in its new layout and confirm the home is fully equipped for day care children.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: RUBALCABA PEREZ, MAGDA
FACILITY NUMBER: 444416841
VISIT DATE: 11/07/2023
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 Applicant states that she will provide Incidental Medical Services (IMS) and medication to children on a case by case basis. Food will be prepared and provided by the FCCH and the Applicant plans to serve breakfast, lunch, dinner and AM/PM snack. The Applicant states she is planning to look into working with food programs such as Community Bridges. Water will be provided for children from the filtered water dispenser in the refrigerator. LPA observed cleaning compounds and kitchen knives properly stored inaccessible to children. All cabinets in the kitchen are equipped with baby locks. The Applicant states there are no weapons or firearms in the home.

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

The bathroom in the home is clean, sanitary, and operable. The Applicant has a small potty seat cover on the toilet. LPA advised having a waste bin with a tight fitting lid for disposing of diapers if children in care are still utilizing them.

LPA toured outside the home and observed the back yard is fenced in. There are bikes and cars to ride on, a wooden play house, and soccer ball and net. The Applicant states that she is planning to add additional equipment to the outside area. There is a water fountain that LPA advised shall be made inaccessible to children. The Applicant states she will follow-up regarding plan for the water fountain. Off limits outside of the house includes front gated yard area for the Applicant's pet dogs. The Applicant states that her dogs will remain in the gated area during day care hours and will come into the home in the evenings to sleep. Shade is provided by canopy and large trees.

LPA observed fully charged 2A10BC fire extinguisher (last serviced: 9/2023), working 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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: RUBALCABA PEREZ, MAGDA
FACILITY NUMBER: 444416841
VISIT DATE: 11/07/2023
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 Applicant states that for discipline of the children, she will talk verbally with the child and use redirection as needed. The Applicant states that she may consider creating a calming corner for the children as well. 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 near the downstairs restroom with a napping cot, until the parent/guardian arrives to pick-up. LPA discussed isolation strategies and utilizing a baby gate for further isolation if the sick child needs access to the restroom due to symptoms.

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 not plan to transport children and 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. LPA advised the Applicant that infants are children under 2 years of age. The Applicant understands the requirements of one child in kindergarten or elementary school and at least one child age six for capacity of eight (complete LIC9150). There should never be more than four infants present at the FCCH.

LPA reviewed with the Applicant LIC 311D- Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. LPA discussed required postings with Applicant and provided copies of Parents Rights bulletin (PUB394) and Earthquake Preparedness Checklist (LIC9148). LPA discussed Provider Information Notices (PINs). LPA additionally reviewed CCLD website and online annual fee payment.

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.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: RUBALCABA PEREZ, MAGDA
FACILITY NUMBER: 444416841
VISIT DATE: 11/07/2023
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 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 with the Applicant, Magda "Nallely" Ruvalcaba Perez.

LPA advised the Applicant that a small FCCH license will be issued pending manager review and completion of the following corrections:
-Order napping cots/mats and sheets for day care children
-Update facility sketch (LIC999A) for updates to on/off limits areas
-Fireplace shall be screened to prevent access by children
-Submit plan of action for water fountain in outside area
-Add additional supplies and play equipment for children in care
-Hang up required postings

Follow-up visit is currently scheduled for Monday, November 20th at 1:00PM
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4