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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354417852
Report Date: 09/10/2024
Date Signed: 09/10/2024 04:33:11 PM

Document Has Been Signed on 09/10/2024 04:33 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:CONTRERAS, TERESAFACILITY NUMBER:
354417852
ADMINISTRATOR/
DIRECTOR:		TERESA CONTRERASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 228-2164
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
09/10/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Teresa ContrerasTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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On 09/10/24 at 1:45 PM., LPA Teodoro Trujillo met with applicant, Teresa Contreras, and conducted a pre-licensing inspection for location change at this facility. Applicant's current license is 354417600 located at 1220 Wright Rd. The adults that reside in this home are Applicant and her husband Samuel with a five year-old child. Days and hours of operation will be Monday to Saturday from 4:00 am to 11:00 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 06/10/25. Applicant owns the home. LPA reminded the Applicant that she cannot care for more than 14 children. Applicant has liability insurance for her current license. 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. There are no stairs in the home. LPA observed a barricaded fireplace with a glass screen door. Off limit areas inside the home: master bedroom, master bathroom, one bedroom, and attached garage. The back right bedroom closest to the master bedroom (day care room) will be used for changing diaper and 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 left and right side yard area, rear yard are that is not enclosed by the sunroom. Applicant states that there are no weapons in the home. Applicant states there will be a dog and two cats in this home, and are 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 09/10/24 to be continued on next page: - Pg 1 of 3 –
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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: CONTRERAS, TERESA
FACILITY NUMBER: 354417852
VISIT DATE: 09/10/2024
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A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 09/06/2024 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. Applicant Teresa Contreras 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.

Forms of discipline used by Applicant: talking to children and redirection.

Applicants 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.
Facility Evaluation Report dated 09/10/24 to be continued on next page: - Pg 2 of 3 –
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
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: CONTRERAS, TERESA
FACILITY NUMBER: 354417852
VISIT DATE: 09/10/2024
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Facility Evaluation Report dated 09/10/24 to be continued from previous page: page 2 of 3.

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.

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 07/17/24. Applicant understands that the training is to be completed every two years.

Fire clearance was granted on 08/26/24 by the Hollister Fire Department.
No deficiencies were cited during today's visit.

LPA informed licensee that an increase of capacity to a large family childcare home is approved pending the following:

-Management's approval



Exit interview was conducted and report was reviewed with Applicant, Teresa Contreras.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC809 (FAS) - (06/04)
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