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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354417784
Report Date: 10/16/2024
Date Signed: 10/16/2024 10:53:41 AM

Document Has Been Signed on 10/16/2024 10:53 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:BASURTO, OFELIAFACILITY NUMBER:
354417784
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 2DATE:
10/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Ofelia BasurtoTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Martha Jimenez-Villanueva conducted an unannounced Case Management inspection to the home today. LPA explained licensee Ofelia Basurto the purpose of the visit is to inspect her Family Child Care Home for the increase of capacity. Licensee has applied for increase of capacity on September 11, 2024, and her home has been granted a clearance by the Hollister Fire Department on 10/08/2024. LPA observed her own two children: one 3 year old child and an infant 6 months of age were in care during this inspection. Licensee states that herself and her husband are the only adults and your own children ages 9, 7, 3 year old and an infant 6 months, living in this two story home.

Days and hours of operation are Monday to Friday from 5:00AM to 5:00PM. Licensee's pediatric CPR and First Aid certifications are current and will expire on 03/2025. LPA observed Mandated Reporter Certificate dated 03/11/2023.

LPA toured the indoor and outdoor areas of the home. LPA observed there are not bodies of water and not fireplace in the home. LPA observed the stairs are barricaded. Off limit areas inside the home: room number 1 with bathroom, room 2 and 3, the laundry room, one closet, and the attached garage, the second floor is off of limits including: one master bedroom with bath, 2 bedrooms and 1 bathroom. Off limits outdoor areas are: The left side yard. 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 09/03/2024, the home has at least one working smoke detector, and at least one working carbon monoxide detector. LPA observed that licensee is using the back yard as playground for the children in care and it is fenced.
The licensee understands that cleaning products, toxic agents, medications, and sharp objects shall not be accessible to children. Licensee states that there are no weapons and no pets in the home.

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. Graphical material showing ratio for a large FCCH license was provided to the licensee.

Report continues LIC 809-C page 2.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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: BASURTO, OFELIA
FACILITY NUMBER: 354417784
VISIT DATE: 10/16/2024
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Report page 2

A review of staff records on 09/24//2024 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Licensee was reminded that all the 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.

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 Ofelia Basurto in Spanish.

Licensee Ofelia 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: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
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