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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354417798
Report Date: 05/31/2024
Date Signed: 05/31/2024 12:44:57 PM

Document Has Been Signed on 05/31/2024 12:44 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:GONZALEZ JUAREZ, KENINAFACILITY NUMBER:
354417798
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/31/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Kenina Gonzalez Juarez
TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 05/31/24 at 09:59 LPA Teodoro Trujillo met with applicant, Kenina Gonzalez Juarez, and conducted a pre-licensing inspection for location change and increase of capacity at this facility. Applicant's current license is #354417631. The adults that reside in this home are Applicant and her spouse Jairo with four children: one preschool age, and three school age; 2 year old, 7, 9 and 12 year-old children. Days and hours of operation will be Monday to Saturday from 5:00 am to 5:30 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 11/05/24. Applicant owns the home and copy of control of property was provided during the visit. LPA reminded the Applicant that she cannot care for more than 14 children for day care. Applicant does not have liability insurance for her current license, and 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. The home is located in a mobile home park with a shared gated community pool, applicant understand the pool is off limits. There are no stairs in the home. Off limit areas inside the home: master bedroom, master bathroom, one
Facility Evaluation Report dated 05/31/24 to be continued on next page: - Pg 1 of 4 –
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024
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: GONZALEZ JUAREZ, KENINA
FACILITY NUMBER: 354417798
VISIT DATE: 05/31/2024
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Facility Evaluation Report dated 05/31/24 to be continued from previous page:
bedroom, the rear enclosed patio room. The front enclosed patio(day care room) will be used for napping. LPA observed a fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detector. LPA observed children play area is fenced in the left and rear backyard, and no bodies of water. Off limit areas outside the home: rear right side restricted carport area. Applicant states that there are no weapons in the home. Applicant states there no pets in the home. 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.

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 5/29/24 was reviewed and it indicates that all Facility staff or other individuals who require caregiver background clearances have not received criminal record and child abuse index clearances or exemptions. Applicant Maria Kenina Gonzalez Juarez 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. Joint Tennant, Fernando Gonzalez is Co-owner of the home, needs to have background check.

Forms of discipline used by Applicant: talking to children and redirection.
Facility Evaluation Report dated 05/31/24 to be continued on next page: - Pg 2 of 4 –
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
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: GONZALEZ JUAREZ, KENINA
FACILITY NUMBER: 354417798
VISIT DATE: 05/31/2024
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Facility Evaluation Report dated 05/31/24 to be continued from previous page:
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. Website for provider resources: https://cdss.ca.gov/inforesources/Child-Care-Licensing. Periodic information releases accessible by signing up at: www.myccl.ca.gov.

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 reviewed infants safe sleep policies with Applicant.
Facility Evaluation Report dated 05/31/24 to be continued on next page: - Pg 3 of 4 –
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
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: GONZALEZ JUAREZ, KENINA
FACILITY NUMBER: 354417798
VISIT DATE: 05/31/2024
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Facility Evaluation Report dated 05/31/24 to be continued from previous page:
Website to complete training: https://mandatedreporterca.com. A link to the alternate trainers approved to provide mandated reporter training:
https://www.cdss.ca.gov/Portals/9/CCLD/CCP%20Documents/Approved%20Mandated%20Reporter%20Trainings.pdf. Applicant completed her training on 05/24/24. Applicant understands that the training is to be completed every two years.

Fire clearance was conducted and approved on 05/09/24 by the Hollister Fire Department. License for a Large Family Child Care Home is approved pending on the following:

1. Association of the fingerprint clearances of Applicant's co-owner Fernando to this facility.
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SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC809 (FAS) - (06/04)
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