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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354414489
Report Date: 12/20/2023
Date Signed: 12/20/2023 03:08:48 PM

Document Has Been Signed on 12/20/2023 03:08 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:FLORES, SONIAFACILITY NUMBER:
354414489
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
12/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Sonia Flores HerreraTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Deanna Villagrana and Doni Fici met with licensee Sonia Flores Herrera for a case management visit. LPAs explained the nature of the visit. Present were licensee, licensee's three adult children and six day care children including two infants.

Licensee requested to add the backyard for day care use. LPAs observed the backyard is safe for children. Off limit area is left side of the yard that is fenced off to children. LPAs observed dog feces on the concrete. Licensee understands backyard must be cleaned at all times prior to children accessing backyard including dog feces. Licensee was informed that backyard is approved for outdoor play as of today. LPAs observed two infants asleep in play yards. Both children were observed with blankets in their play yards and one child had on blanket hanging over play yard. LPAs observed play yards did not have a fitted sheet. LPA Villagrana requested to see Safe Sleep log. LPAs observed licensee did not have a completed Safe Sleep log for one infant in care. LPA Villagrana provided Safe Sleep Regulations to provider. LPAs observed steak knives in a kitchen drawer and wood glue on a kitchen counter accessible to children.

The following type A and B deficiencies were cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies 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.

LPAs Deanna Villagrana and Doni Fici informed licensee Sonia Flores Herrera that this report dated 12/20/2023 document(s) 2 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: FLORES, SONIA
FACILITY NUMBER: 354414489
VISIT DATE: 12/20/2023
NARRATIVE
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Also, LPAs Deanna Villagrana and Doni Fici informed the licensee Sonia Flores Herrera to provide a copy of this licensing report dated 12/20/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/20/2023 03:08 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 12/20/2023 at 02:12 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: FLORES, SONIA
FACILITY NUMBER: 354414489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/21/2023
Section Cited
CCR
102425(b)

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Cribs or play yards shall be free from all loose articles and objects.
This requirement was not met as evidenced by children were observed with blankets in their play yards. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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Licensee will submit a statements stating she has read Safe Sleep regulations and understands them to CCLD by POC date.
Type A
12/20/2023
Section Cited
CCR
102417(g)(4)

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Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
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Licensee removed items during visit. Deficiency cleared today.
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This requirement was not met as evidenced by LPAs observed steak knives in a kitchen drawer and wood glue on a kitchen counter accessible to children. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/20/2023 03:08 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 12/20/2023 at 02:24 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: FLORES, SONIA
FACILITY NUMBER: 354414489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/22/2023
Section Cited
CCR
102425(a)(3)

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Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.
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Licensee will submit photos of fitted sheets to CCLD by POC date.
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This requirement was not met as evidenced by LPAs observed play yards did not have a fitted sheet. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
12/22/2023
Section Cited
CCR102425(j)(2)(D)

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Documentation shall be maintained in the infant’s file and be available to the Department for review. This requirement was not met as evidenced by LPAs observed licensee did not have a completed Safe Sleep log for one infant in care.
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Licensee will submit Safe Sleep log for the remainder of this week for infants in care as she will be closed throught the rest of the year. Licensee will also read Safe Sleep Regulations.
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This poses a potential risk Health, Safety Personal Rights risk to children in care.
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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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/20/2023 03:08 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 12/20/2023 at 02:32 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: FLORES, SONIA
FACILITY NUMBER: 354414489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/22/2023
Section Cited
CCR
102425(b)(3)

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There shall be no objects hanging above or attached to the side of the crib. This requirement was not met as evidenced by one child had on blanket hanging over play yard. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Licensee will submit a statements stating she has read Safe Sleep regulations and understands them to CCLD by POC date.

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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:Susy Cervantes
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2023


LIC809 (FAS) - (06/04)
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