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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417612
Report Date: 03/07/2023
Date Signed: 03/07/2023 03:32:51 PM

Document Has Been Signed on 03/07/2023 03:32 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:CRUZ CRUZ, NANSYFACILITY NUMBER:
274417612
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 1DATE:
03/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Nansy Cruz CruzTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced Case Management inspection to the home today. LPA explained licensee Nansy Cruz Cruz, the visit is to inspect her Family Child Care Home for the increase of capacity. Licensee has submitted an application for increase of capacity on January 17, 2023 and her home has been granted a clearance by the North County Fire Protection on 2/03/23. Licensee Nansy and her spouse Jesus are the only adults residing in the one story home. Licensee's minor children ages 16, 12, and 9 years old also reside in the home. LPA observed one preschool child was in care during the inspection. Days and hours of operation are Monday to Friday from 6:00 AM to 5:30 PM and Saturdays from 6:00 AM to 3:00 PM. Licensee's pediatric CPR and First Aid certifications are current and will expire on 9/18/23.
LPA toured the indoor and outdoor areas of the home during today's inspection. LPA observed there are not wall heaters in the home. LPA observed there are not bodies of water in the home. LPA observed there are not stairs inside the home. Off limit areas inside the home: 3 bedrooms, one bathroom, and the attached garage. LPA observed the laundry area is located inside the garage. Licensee understands that the garage is not approved for childcare in accordance with the Fire Clearance document. LPA observed licensee has a 3A40BC fire extinguisher in the home, and it was last time serviced on 1/19/23, the home has at least one working smoke detector. LPA observed the home has at least one working carbon monoxide detector. Off limits outdoor areas are: The right and the left side yards, and an storage shed located in the back yard. licensee uses the back yard as playground for the children in care. LPA observed the back yard is fenced. Licensee states that there are no weapons in the home. Licensee understands that cleaning products, toxic agents, medications, and sharp objects shall not be accessible to children.
A review of staff records on 3/06/23 indicates that all the adults residing in the home or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee has completed the required "mandated reporter" training AB1207 on 3/01/22
Licensee understands her capacity options and she understands that she cannot have more than 8 children in the home at any time and ratio must be met.
*********Report dated 3/07/23 continues on page 2.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2023
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 2
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: CRUZ CRUZ, NANSY
FACILITY NUMBER: 274417612
VISIT DATE: 03/07/2023
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Report dated 3/07/23 continues from page 1.

Licensee was informed that if eventually a large license is granted, the maximum capacity is 14 and a qualified helper is required to be present whenever there are more than 8 children in care and ratio (age of the children) must be observed. Licensee understands that in absence of a qualified helper, her license capacity automatically returns to capacity 8 and ratio must be observed as well.

No deficiencies were cited today.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee Nansy Cruz Cruz in Spanish.

Licensee Nansy Cruz Cruz was informed that a large Family Child Care Home license would be approved pending on the following: 1) Approval from a manager of the Licensing Program.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC809 (FAS) - (06/04)
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