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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274414530
Report Date: 04/12/2024
Date Signed: 04/12/2024 06:34:14 PM

Document Has Been Signed on 04/12/2024 06:34 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:RIOS-GUZMAN, DULCE MARIAFACILITY NUMBER:
274414530
ADMINISTRATOR/
DIRECTOR:		RIOS-GUZMAN, DULCE MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 682-6905
CITY:GREENFIELDSTATE: CAZIP CODE:
93927
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
04/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Dulce Maria Rios GuzmanTIME VISIT/
INSPECTION COMPLETED:
06:45 PM
NARRATIVE
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Licensing Program Analyst (LPAs) Martha Jimenez-Villanueva and Fermin Campos-Jaramillo met with licensee, Dulce Maria Rios-Guzman, for an unannounced annual inspection and explained the reason for the visit to her. Present during today's visit were licensee with seven children: six preschool and one infant. LPAs observed licensee was operating as her own. Adults living in the home are licensee and her spouse with three children ages 10, 6 and 3. Days and hours of operation are Monday through Saturday 4:00 AM to 6:00 PM.

LPAs took a picture of a current roster of the children. LPAs observed a fire and disaster drill log that was last conducted on 01/08/24. LPAs reviewed 5 children’s files and observed that some of the required documentation was missing. Infant individual sleeping plan (LIC 9227) for each infant under 12 months was reviewed as well as a 15 minute check sleep log for infants under 24 months and LPAs observed the two infants enrolled were missing the current month (April 2024). LPAs observed that the Licensee and her helper Maritza have Mandated Reporter training, training was renewed on 01/30/24 and 09/09/22 respectively. Licensee and her helper have Pediatric CPR/First Aid expiring 01/20/25 and 03/13/26 respectively. Immunization against Pertussis, Measles, and Influenza as well as TB testing are on file for licensee and helper.

LPA inspected inside and outside of the home. LPAs observed a blocked fireplace, no wall heater, gated stairs, and no bodies of water. Licensee stated there are no weapons. LPAs observed two dogs and licensee stated are vacinnated. LPAs observed a 2A10BC fire extinguisher that was serviced on 01/06/24. Carbon Monoxide detector and smoke detectors were operable. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children and stored in a top kitchen cabinet. Backyard is fenced. Off limit areas: second floor, garage, shed, right and left side yards.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 04/12/2024 06:34 PM - It Cannot Be Edited


Created By: Martha Jimenez-Villanueva On 04/12/2024 at 04:36 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: RIOS-GUZMAN, DULCE MARIA
FACILITY NUMBER: 274414530

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review the licensee did not comply with the section cited above in: LPAs observed assistant is still in process status in Guardian, as of 4/10/24, licensee states her assistant Maritza Torres has been working since September 8, 2022 which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/13/2024
Plan of Correction
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Licensee's helper must submit a live scan as soon as 4/13/24 and licesee will submit proof that her helper has completed the live scan process by the end of business April 13, 2024.
Type A
Section Cited
CCR
102416.5(b)(3)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (3) More than six and up to eight children, without an additional adult attendant, only if the criteria in
Section 1597.44 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in: LPAs observed licensee was providing on her own to seven children, none of the seven have been assisting to pre-school. which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/13/2024
Plan of Correction
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Licensee will submit a declaration to state that she understands the capacity related regulations for small and large capacity and that she understands in absence of a helper her license shall be operated as a small FCCH. Graphic materials for capacity options were provided to the licensee.
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:Belinda Devall
LICENSING EVALUATOR NAME:Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024


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Document Has Been Signed on 04/12/2024 06:34 PM - It Cannot Be Edited


Created By: Martha Jimenez-Villanueva On 04/12/2024 at 04:36 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: RIOS-GUZMAN, DULCE MARIA
FACILITY NUMBER: 274414530

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record record review, the licensee did not comply with the section cited above in:LPAs observed Child (2) and (3) missing complete sleep log which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/12/2024
Plan of Correction
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Licensee will complete the sleep log for the period April 15 to April 24, 2024 and will submit a copy not later than end of business day 04/26/24 and licensee will be continuing documenting the children sleep log until infants reach two years old.
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in: Children (1, 3 and 4) are missing PM 286B Immunization Records. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2024
Plan of Correction
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Licensee will transfer the Immunization records in the form PM 286B and will mail a copy as proof for completion by the end business day 04/26/24.
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:Belinda Devall
LICENSING EVALUATOR NAME:Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024


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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: RIOS-GUZMAN, DULCE MARIA
FACILITY NUMBER: 274414530
VISIT DATE: 04/12/2024
NARRATIVE
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----Report dated 04/12/24, continues from page 1

Licensee stated they do transport children, LPAs reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.
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 assistant must be present. Licensee understands in absence of a helper the capacity of her license is reduced in capacity and ratio to a small Family Child Care Home license, maximum 8. Licensee understands children under the age of ten years old count as part of the capacity of her license. The Licensee states her spouse transports children via vehicle and that he understands that children cannot be left in parked vehicles unattended at any time. Licensee uses redirection and communication with children as a form of discipline.

A review of staff records on 4/10/24 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Licensee was reminded that all the adults 18 and over living or working in the home, 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.
LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at

https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
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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: RIOS-GUZMAN, DULCE MARIA
FACILITY NUMBER: 274414530
VISIT DATE: 04/12/2024
NARRATIVE
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----Report dated 04/12/24, continues from page 2.

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: https://www.ada.gov/resources/child-care-centers/.

LPAs also informed licensee 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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.


Licensee 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.

During the exit interview, the LICENSEE Dulce Maria Rios Guzman confirmed that there are no Registered Sex Offenders living in the facility.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
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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: RIOS-GUZMAN, DULCE MARIA
FACILITY NUMBER: 274414530
VISIT DATE: 04/12/2024
NARRATIVE
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----Report dated 04/12/24, continues from page 3

Exit interview conducted and report was reviewed with the licensee Dulce Maria Rios Guzman

The following type type A and type B deficiencies were cited on the attached page (809-D).

Licensee was informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

LPA discussed the requirements of AB633 to the licensee Dulce Maria. LPA provided licensee the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) both in English and in Spanish and licensee stated she understands the requirements. Upon receipt, the licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.



Licensee rights were provided to the licensee Dulce Maria in Spanish and in English.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
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