354417450-12-3-2024-07-CC-MJVA-DBM2JZ-20241203162711

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 354417450
Report Date: 12/03/2024
Date Signed: 12/03/2024 04:27:21 PM

Document Has Been Signed on 12/03/2024 04:27 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:	VALLE, SUSANA		FACILITY NUMBER:	354417450
ADMINISTRATOR/ DIRECTOR:	SUSANA VALLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 537-3713
CITY:	HOLLISTER	STATE: CA	ZIP CODE:	95023
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	12/03/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:40 PM
MET WITH:	Susana Valle		TIME VISIT/ INSPECTION COMPLETED:	04:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Martha Jimenez-Villanueva conducted an announced pre-licensing inspection. LPA met with Applicant Susana Valle and explained the reason for the inspection. The purpose of this inspection is for a change of location. Applicant was present with her daughter. Applicant is currently licensed at 1240 El Toro Drive, Hollister CA 95023; facility number 354415568. Applicant stated stop activities for childcare since November 6, 2024. The City of Hollister Fire Department granted a fire clearance on November 18, 2024. The applicant stated that herself, her husband, her daughter are the only adults residing in the home. Applicant stated also her son thirteen-year-old is living with her. The home is one story home with 3 bedrooms and 2 baths. The days and hours of operation will be Monday to Friday from 5:00AM to 5:30PM. The applicant understands that the children cannot stay in the home for more than 24 continue hours. Applicant has completed her Preventative Health and Safety Child Care Training included the lead poisoning training on 10/29/2017. Applicant's pediatric CPR and First Aid certifications are current and will expire in January 2026. Applicant has completed the Mandated Reporter Training on July 16, 2024. LPA observed proof of immunization for measles, pertussis and influenza are in the applicant's file. Applicant rents/leases the home, proof of landlord notification (LIC 9151) is required and a copy is on file. Applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149) on file. Applicant provided proof of control of property to the Department prior to today’s inspection and a copy of the lease agreement is on file. Applicant has a current Liability insurance with Markel and expired December 02, 2025. LPA toured the indoor areas of the home during today's inspection. LPA observed central heater and air conditioner at home for safety and comfort. LPA observed not bodies of water, not stairs and not weapons in the home. LPA observed a glass covered fireplace in the living room. Off limits areas in the home are one master bedroom with tub, two bedrooms, one bathroom, laundry room and attached garage. The garage is not approved for day-care use per Fire Department. LPA observed doorknobs cover in the off-limits areas. Off limits areas outside are right side yard (barricaded) and the front yard and driveway. The backyard will be using as a play area and outdoor activities. The backyard is barricaded. LPA observed two dogs in the home, applicant stated dogs are vaccinated and stay in the garage and the right-side yard (barricaded). Applicant understands that cleaning products, toxic agents, medications, and sharp objects shall not be accessible to children and these products are in a top cabinet of the kitchen and in the laundry area. LPA observed fully charged fire extinguisher 3A40BC which was serviced on 04/09/2024 and a pull station fire alarm. LPA observed the home has at least one combo smoke/Carbon Monoxide detector. Applicant understands that prior to making any change related to the on or off limits must be reported to Licensing Program. Report continues in LIC 809-C page 2

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024

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: VALLE, SUSANA	FACILITY NUMBER: 354417450
	VISIT DATE: 12/03/2024

NARRATIVE

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Report LIC 809-C page 2

LPA reminded applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes.
Forms of discipline applicant will use: Talking with 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 for a Large license, 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.cdss.ca.gov provided to applicant.

LPA discussed the requirements of AB 633 with the applicant. LPA also discussed "zero tolerance" related regulations with the applicant.

A review of staff records on 12/03/2024 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. Applicant 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, 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.

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) or (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.

Report continues in LIC 809-C page 3

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024

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: VALLE, SUSANA	FACILITY NUMBER: 354417450
	VISIT DATE: 12/03/2024

NARRATIVE

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Report LIC 809-C page 3

LPA reviewed with applicant, the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant and, discussed the Child Care Licensing Safe Sleep web page athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

On the date, 11/07/2024 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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

Exit interview conducted and report was reviewed with the applicant Susana Valle in Spanish.

Applicant Susana Valle 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: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024

LIC809 (FAS) - (06/04)

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