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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417728
Report Date: 10/26/2023
Date Signed: 10/26/2023 10:59:54 AM

Document Has Been Signed on 10/26/2023 10:59 AM - 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:DELGADO HERNANDEZ, ROSALIAFACILITY NUMBER:
274417728
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/26/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:38 AM
MET WITH:Rosalia Delgado HernandezTIME COMPLETED:
11:15 AM
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LPA Teodoro Trujillo met with applicant, Rosalia Delgado Hernandez, and conducted a pre-licensing inspection for location change at this facility. Applicant's current license is #274416048 located at 966 Nantucket Blvd. Apt 101, Salinas Ca. The adults that reside in this home are Applicant and her Spouse Artemio, adult son Alexis, adult daughter Daniela with a 15 year-old child. Days and hours of operation will be Monday to Friday from 6:00 am to 6:00 pm. Applicant has completed her Preventative Health and Safety Child Care Training with the lead poisoning prevention module and a copy of certifications verifying completion is in file. Applicant's CPR and First Aid certifications are current and expire on 02/06/25. Applicant rents the home and the Owner/Landlord Notification form (LIC 9151) is in file. LPA reminded the Applicant that she cannot care for more than 8 children unless she obtains the Owner/Landlord consent for day care. Applicant has liability insurance for her current license, and it will be renewed under this facility once licensed. Applicant understands that if she decides not to carry liability insurance in the future, she will have parent/authorized representative sign the Affidavit Regarding Liability Insurance for FCCH form (LIC 282).

LPA toured the indoor and outdoor areas during today's visit. LPA observed barricaded stairs in the two story home, glass door on first floor fire place. Off limit areas inside the home: all second floor rooms, attached garage, and laundry room.

First floor bedroom will be used for napping. LPA observed a fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detector. LPA observed a fenced backyard, and no bodies of water. Off limit areas outside the home: the gated restricted area. Applicant states that there are no weapons in the home. Applicant states there will be a dog in this home, and it is vaccinated. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. LPA reminded Applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes.

Facility Evaluation Report dated 10/26/23 to be continued on next page: - Pg 1 of 3 –
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023
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 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: DELGADO HERNANDEZ, ROSALIA
FACILITY NUMBER: 274417728
VISIT DATE: 10/26/2023
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Facility Evaluation Report dated 10/26/23 to be continued from previous page:

A listing of staff criminal record clearances associated to this facility in the Guardian system was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. Rosalia, was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Forms of discipline used by Applicant: talking to children and redirection.
Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

Department website: www.ccld.ca.gov provided to Applicant.
LPA discussed the requirements of AB 633 with the Applicant and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Applicant understands the requirements. LPA also discussed "zero tolerance" related regulations with the Applicant and advised her of the assessment of an immediate $500 civil penalty, and an ongoing $100 per day per violation continues until the violation(s) is corrected.

AB792 Immunization Requirements was discussed. LPA observed the required immunization records for Applicant and her husband were in file.

LPA provided and discussed the safe sleep regulations with Applicant 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 Applicant 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
Facility Evaluation Report dated 10/26/23 to be continued on next page: - Pg 2 of 3 –
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
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: DELGADO HERNANDEZ, ROSALIA
FACILITY NUMBER: 274417728
VISIT DATE: 10/26/2023
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Facility Evaluation Report dated 10/26/23 to be continued from previous page:

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:
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: http://www.ada.gov/childqanda.htm
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicant, Rosalia Delgado Hernandez, and LPA advised her that a small Family Child Care Home License is approved pending Licensing Program Manager approval.
Facility Evaluation Report dated 10/26/23 to be continued on next page: - Pg 3 of 3 –
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
LIC809 (FAS) - (06/04)
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