Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415784
Report Date: 06/05/2018
Date Signed: 06/05/2018 12:20:45 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:HEREDIA ANTON, MARIAFACILITY NUMBER:
434415784
ADMINISTRATOR:HEREDIA ANTON, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 630-9010
CITY:PALO ALTOSTATE: CAZIP CODE:
94301
CAPACITY:14CENSUS: 0DATE:
06/05/2018
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria Anton Heredia TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Zaid Hakim conducted an Announced Pre-Licensing Inspection at the prospective facility today. Upon arrival, LPA met with the Licensee Applicant - Ms. Maria Anton Heredia and Ms. Karla Infante Lopez. Ms. Maria, her spouse, and Ms. Karla are the only individuals that reside in the home and all maintain valid fingerprint clearances. At the time of the inspection, LPA confirmed the facility sketch is accurate and that the prospective facility has obtained an approved fire clearance for a maximum of 14 children. Days and hours of operation will be Monday through Friday 8:00am to 5:00pm.

The applicant maintains valid health, safety, and nutrition training completed in April of 2018 and pediatric CPR and First Aid certification with an expiration month of April 2020. The applicant stated that she intends on obtaining liability insurance and has agreed to submit a copy to Community Care Licensing (CCL) as soon as available.

LPA toured all indoor and outdoor day care areas during the inspection. The off limits areas include the detached garage and one portion of the backyard (left side) that is physically separated with a fence. All other areas are available for day care use. The facility is located on a shared duplex property that has a separate address and is physically separated from the facility address. LPA observed door locks to secure certain areas of the home. LPA observed at minimum 1 fully charged 2A40BC fire extinguisher, 1 functional smoke detector, 1 functional carbon monoxide detector, and first aid supplies. The kitchen was observed to have functional appliances. The Licensee Applicant stated that she will be serving meals and snacks and that children will be served meals in the main activity room. The Licensee Applicant stated that parents will be informed of what foods may be served at the facility at any given time and understands that food allergies and dietary restrictions should be followed and outlined in children's files. The Licensee Applicant stated that there are no bodies of water or fireplaces on the premises and no weapons or firearms stored in the home.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 06/05/2018):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2018
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: HEREDIA ANTON, MARIA
FACILITY NUMBER: 434415784
VISIT DATE: 06/05/2018
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 06/05/2018):

LPA observed that all toxic cleaning supplies or items that pose a danger to children are stored in secure and inaccessible locations. The indoor common area was observed to be organized and equipped with age appropriate toys and supplies. The Licensee Applicant stated that children will nap in the activity room. LPA observed an adequate amount of furniture and items for napping, including two cribs and pillows and blankets. There is a common area available for required postings by the front entrance and there is a designated area to store children's files and facility information. The Licensee Applicant stated that she understands which items are required to be posted during facility operation.

LPA observed the outdoor activity area to be equipped with age appropriate toys and supplies that are safe for children. LPA observed that the outdoor play area is equipped with secure perimeter fencing. The Licensee Applicant stated that the sandbox will be covered at night and understands outdoor supervision regarding children's safety. The Licensee Applicant does not have any pets at this time. At the time of the inspection LPA obtained photos of the facility physical plant to be placed on file.

-The Licensee Applicant does not intend on assisting children with any medications at this time.
-The Licensee Applicant stated that she will not be providing transportation and understands the following: written approval shall be obtained from parents if transportation is provided, children may not be left alone and shall be supervised at all times when being transported, seat belt and car seat laws must be obeyed at all times, and the applicant is responsible for ensuring that the vehicle used to transporting children is safe maintained regularly. The Licensee Applicant stated she will be using talking and redirection as forms of discipline. LPA informed the applicant that time out can only be used one minute per year of age. The Licensee Applicant stated she understands that children's personal rights should not be violated; including no corporal punishment. LPA and the applicant discussed isolation of sick children, supervision of children, capacity options, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, requirements for assistant/substitute, and immunization requirements for staff including the new regulation regarding Pertussis, Measles, and Influenza.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3 - REPORT DATED 06/05/2018):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2018
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: HEREDIA ANTON, MARIA
FACILITY NUMBER: 434415784
VISIT DATE: 06/05/2018
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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 06/05/2018):

LPA informed the applicant that fire/disaster drills must be practiced at least once every 6 months, must be documented, and must be available for review by the department. LPA discussed the requirements of AB 633, recent updates to the car seat law, healthy beverages in child care, and safe sleep for infants.
LPA and the applicant discussed emergency disaster procedures including supplies in the home, lock down procedures, as well as protocols and supplies in the event of having to leave the facility. LPA and the Licensee Applicant discussed methods of payment of licensing fees and updating facility information.

A review of staff records during today's inspection indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded the applicant 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Applicant has been informed that upon arrival children must be removed from car seats, that bouncers are prohibited from Family Home Day Cares, and that children may not be held in high chairs when not feeding or preparing for feeding time. LPA and the Applicant discussed the Community Care Licensing Division website and discussed access to general updates, changes to Title 22 regulations, health and safety codes, the role of the Licensing Program Analyst (LPA) and other ongoing licensee requirements and responsibilities. LPA advised that licensing forms and all other information can be found at: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #4 - REPORT DATED 06/05/2018):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2018
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: HEREDIA ANTON, MARIA
FACILITY NUMBER: 434415784
VISIT DATE: 06/05/2018
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CONTINUATION OF PREVIOUS PAGE (PAGE #3 - REPORT DATED 06/05/2018):


Based on today's inspection, the facility physical plant has been APPROVED for licensure pending Community Care Licensing management approval and completion of the items listed below:

- The Licensee Applicant(s) have agreed to submit an updated LIC 279 to add a Co-Licensee
(Karla Infante Lopez)
- Official Training Certificate for the 8 Hour Preventive Health, Safety, and Nutrition Course
- Official Training Certificate for the required Mandated Reporter Training per AB 1207
http://www.mandatedreporterca.com/training/childcare.htm
- Official Training Card for the required Pediatric CPR / First Aid training
** All items listed above should be maintained for all individuals listed on the License, in addition to immunization requirements.


Exit interview conducted with Ms. Maria Anton Heredia, Licensee Applicant , and Ms. Karla Infante Lopez.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2018
LIC809 (FAS) - (06/04)
Page: 4 of 4