Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413653
Report Date: 09/27/2018
Date Signed: 09/27/2018 04:15:46 PM

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:TERRAZAS, AMORFACILITY NUMBER:
434413653
ADMINISTRATOR:TERRAZAS, AMORFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 468-1788
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:14CENSUS: 10DATE:
09/27/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Amor TerrazasTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual random inspection to the home today. LPA met with Amor Terrazas, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 8:30 AM to 4:30 PM The adults that reside in the home are the Licensee and her spouse Gaston. Present in today's inspection were 10 preschool age children in care. Licensee's certifications for CPR and First Aid is current and will expire on 9/01/2020. Present was also licensee's helper Ana Ruiz. Ana's CPR and First Aid card will expire on 09/01/2020.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the children's roster and it is current. LPA reviewed the 5 children's files and are complete with the required forms. LPA observed a Fire/Disaster drill was documented on 8/13/2018. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas in the home are three bedrooms and one bathroom. Off limits areas outside the home is the left side yard. LPA observed the home has a back yard and it is fenced. LPA observed that the licensee has the children playground in the back yard.
LPA observed a fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detectors and no bodies of water. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. LPA discussed IMS with the Licensee. LPA observed proof of immunization for Licensee for pertussis, measles and influenza is in file according with the SB792. LPA observed that licensee's helper Ana Ruiz, does not have available proof of immunization and will submit proof to Licensing Department, and Licensee understands this is a deficiency to the Health and Safety Regulations.
A review of staff records on 09/10/2018 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Report dated 09/27/2018 continues in page 2.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2018
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: TERRAZAS, AMOR
FACILITY NUMBER: 434413653
VISIT DATE: 09/27/2018
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Report dated 09/27/2018 continues from page 1.

LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a helper must be present. Licensee understands that without a helper, her licensee capacity is reduced to only 8 children. The Licensee states that she does not transport children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.
LPA advised to licensee that she and her helper shall complete the AB1207 mandated reporter training for child care workers in California. Licensee understands that the Mandated Reporter Training shall be taken for all adults who are in contact with the children in care. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information on the online training. LPA discussed the requirements of AB 633. LPA also discussed "zero tolerance" related regulations with the Licensee.


LPA included in this report the Department website: www.ccld.ca.gov

There were two type B deficiencies cited during today's inspection. Appeal rights was printed and given to Licensee. Exit interview and inspection was conducted with licensee in Spanish.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2018
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: TERRAZAS, AMOR
FACILITY NUMBER: 434413653
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2018
Section Cited
HSC
1597.622(a)(1)
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Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Licensee shall obtain proof of immunization for Ana Ruiz for measles, pertussis and influenza and will submit a copy to Licensing Department by 10/11/2018.
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LPA observed that licensee's helper Ana Ruiz, does not have available proof of immunization and will submit proof to Licensing Department, and Licensee understands this is a deficiency to the Health and Safety Regulations and a potential risk to the children in care.
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Type B
11/10/2018
Section Cited
HSC
1596.8662(b)(1)
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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated
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Licensee shall obtain the certificate for herself and for her helper Ana for the Mandated Reporter training and will submit a copy to the Licensing Department.
Licensee understands that in the future the Mandated Reporter Training shall be taken for all adults who are in contact with the children in care.
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reporter training every two years following the date on which he or she completed the initial mandated reporter training.


LPA observed that the licensee and her helper have not taken the Mandated Reporter training in accordance with the AB1207.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2018
LIC809 (FAS) - (06/04)
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