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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417625
Report Date: 09/13/2024
Date Signed: 09/13/2024 01:30:38 PM

Document Has Been Signed on 09/13/2024 01:30 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:SABALSA, BLANCAFACILITY NUMBER:
274417625
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
09/13/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Blanca SabalsaTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analysts (LPA) Andy Yang and Licensing Program Manager (LPM) Belinda Devall met with Licensee, Blanca Sabalsa to conduct an unannounced annual inspection for capacity increase to Large Family Care Home. LPA noted that Applicant resides in a home and the unit faces the street in the court. LPA was granted access to the home by the Licensee at 9:30am. Licensee and Assistant were the only adult present in the home during today's inspection. LPA observed 5 children (2 infant 3 preschoolers) in care during hours of operation. Licensee and domestic partner (Sergio Tamayo) are the only adults residing in the home. There is one minor child residing in the home.

Days and hours of operation will be Monday - Friday from 5:00 AM to 5:00 PM. The current capacity is Small Family Care home with capacity of 8. Licensee completed her Preventative Health and Safety Training on 12/10/2022 and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 12/17/2024. Licensee completed the Mandated Reporter Training for Child Care Workers on 9/28/2022 and a copy of the certification is on file. A copy of current TB test, MMR, Tdap, and flu vaccinations for the Applicant are on file. Because domestic partner owns the home, proof of landlord notification is required. Licensee has proof of liability insurance. LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the licensee confirms was provided to the property owner/landlord. Licensee obtained a signed Property Owner/Landlord Consent form (LIC 9149) for Small Family Care Home. Copies of both documents are on file.

LPA and LPM toured the indoor and outdoor areas of the home with the Licensee during today's inspection. There are no stairs and wall heater units inside the home. Off limit areas inside the home include: master bedroom, kitchen (barricaded), barricaded living room (front near entrance), laundry room, studio and 2 back bedrooms. Off limit areas outside the home include: driveway, backyard, and front yard. On Limit areas include: dining room (converted to child care area, located between living room and kitchen), day care room 2 (converted from a bedroom, located next to dining room), side yard and bathroom.

The home is clean, orderly, including heating and ventilation, for safety & comfort. The Licensee has a valid cell phone in the home. There is sufficient toys, supplies, and equipment for the day care children both indoors/outdoors.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2024
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 3
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: SABALSA, BLANCA
FACILITY NUMBER: 274417625
VISIT DATE: 09/13/2024
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Licensee stated that she has firearms located in the home. LPA and LPM inspected the gun safe, and all firearms were locked and ammunition is located outside away of home.

LPA observed a fully charged fire extinguisher (2A10BC), working combo smoke & carbon monoxide detectors, no bodies of water, and fenced backyard. Licensee has 2 dogs located in off limit area.

Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. Applicant states that any poisons are stored in laundry room (Off limit). LPA reminded licensee that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. Licensee states that she will not administer any medication to the children at this time. Licensee states that a child will be isolated in the living room if necessary due to illness or communicable disease.

Forms of discipline to be used by Licensee: (talking to children & redirection). Licensee understands that children's personal rights should not be violated; including no corporal punishment. isolation of sick children, supervision of children, capacity options, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed the Licensee that fire/disaster drills must be practiced at least once every 6 months and documented. LPA has inspected Licensee fire/disaster drill which is compliant and located in file.

Licensee was reminded that all 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.



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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SABALSA, BLANCA
FACILITY NUMBER: 274417625
VISIT DATE: 09/13/2024
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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-andresources/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.

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/.

Licensee was informed of the MyChildCarePlan.org website; aconsumer 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, Blanca Sabalsa, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Megan's Law was checked on 9/12/2024.

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

Exit interview conducted and report was reviewed with the Licensee, Blanca Sabalsa. LPA advised the Licensee that a Large Family Child Care Home license will be approved upon completion of the following:

1) Updated Property Owners/Landlord Consent Form LIC 9149
2) Pictures of converted bedroom used for daycare
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
LIC809 (FAS) - (06/04)
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