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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415959
Report Date: 06/26/2024
Date Signed: 06/27/2024 07:58:59 PM

Document Has Been Signed on 06/27/2024 07:58 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:GONZALEZ ANAYA, ARACELIFACILITY NUMBER:
274415959
ADMINISTRATOR/
DIRECTOR:		ARACEI GONZALEZ ANAYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 789-5946
CITY:SOLEDADSTATE: CAZIP CODE:
93960
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 10DATE:
06/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Araceli Gonzalez AnayaTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo met with licensee, Araceli Gonzalez Anaya, for an annual inspection and explained the reason for the visit to her. Present during today's visit were licensee, and her helpers Michelle and Elvia. Adults living in the home are licensee, her spouse Francisco, her parents Elvia and Jenaro, and her daughter Michelle with four minor children ages 13, 10, 6, and 3 years old. Days and hours of operation are Monday through Friday 5:00 AM to 5:00 PM.

LPA inspected inside and outside of the home. LPA observed no fireplace, no wall heater, no stairs, and no bodies of water. Licensee stated there are no weapons. Licensee stated they have a cat and two dogs and they are vaccinated. LPA observed a fully charged 2A10BC fire extinguisher. 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 and bedroom. Backyard is fenced. Off limit areas: three bedrooms, one bathroom, garage, shed, and right left side yards.

LPA went over substitute options and reminded licensee they could only have 14 children according to their license, and ratio (age of the children) must be observed. Licensee was reminded in absence of a helper her license is automatically reduced to capacity 8 and ratio must be observed as well. Licensee stated they do not transport children, LPA 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.



LPA reviewed five children files, took pictures of the children roster, and observed licensee has documented disaster drills on 6/12/24 and 6/24/24. LPA observed that the Licensee has Mandated Reporter training, training was completed on 09/29/22, and her helpers Michelle and Elvia on 4/6/23 and 4/2/23 respectively. Licensee has Pediatric CPR/First Aid expiring 09/17/2024, and her helpers on 3/25/25. LPA observed in file the needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing for the adults in contact with children.

*****Report dated 6/26/24 continues on page 2.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GONZALEZ ANAYA, ARACELI
FACILITY NUMBER: 274415959
VISIT DATE: 06/26/2024
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Report dated 6/26/24 continues from page 1.

A review of staff records on 6/18/24 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 adults 18 and over living or working in the home, 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 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 with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing IMS at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

LPA discussed the safe sleep regulations with licensee 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 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 will 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 tools, please send them by email 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/process.

No deficiencies were cited during today's visit.


Exit interview conducted and report was reviewed in Spanish with the licensee, Araceli Gonzalez Anaya.
A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC809 (FAS) - (06/04)
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