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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430757125
Report Date: 01/14/2025
Date Signed: 01/14/2025 12:12:06 PM

Document Has Been Signed on 01/14/2025 12:12 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:CRUZ, GUADALUPEFACILITY NUMBER:
430757125
ADMINISTRATOR/
DIRECTOR:		CRUZ, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 225-2941
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
01/14/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Licensee Guadalupe CruzTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analysts (LPAs), Jaime Gonzales and Farida Raja met with Licensee Guadalupe Cruz, for an unannounced Required- 1 Year Inspection. LPAs were granted access to the home by daughter and assistant Sarai Cruz and toured both indoors during the inspection. Upon arrival, there were 1 infant and 4 preschool children and 1 assistant present, which is compliant with the home license capacity and ratio requirements. LPAs did not observed all required postings near the entrance to the home. LPAs were able to review the posting on the fridge and advised licensee to have required posting where it is visible to authorized representatives. Hours of operation for the facility are Monday – Friday, 6:30AM-5PM.

Licensee states that adults, over the age of 18, residing in the home are: the licensee and her husband (Beltran Cruz). All adult(s) residing in the home have Criminal Background Check Clearance.

Licensee 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.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jaime Gonzales
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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: CRUZ, GUADALUPE
FACILITY NUMBER: 430757125
VISIT DATE: 01/14/2025
NARRATIVE
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LPAs reviewed facility roster (LIC9040) and fire drill log during todays inspection. The last fire drill was conducted on 12/17/2024, which is compliant with the six-month requirement for homes. LPAs observed a fully charged 3A40BC fire extinguisher that was last serviced on 02/27/2024. LPAs observed a functioning combination smoke and carbon monoxide detector. Assistant stated that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. The licensee stated that there are no weapons or firearms in the home.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Indoor areas of the home were inspected by the LPAs today and observed to be clean, orderly, and safe for the day care children. Off-limits areas of the home (indoors): All bedrooms, master bathroom and garage. LPAs observed heaters that are installed in the ceiling and a barricaded fireplace in the family room. Licensee understands that she cannot use the fireplace units during day care hours. LPAs observed sufficient age-appropriate materials, toys, and play equipment in the home. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. Drinking water is readily available for children in the facility via water bottles labeled with the children’s names. LPAs observed 1% milk in the fridge that expired on 01/13/25, LPAs advised to remove from the fridge and to check expiration dates prior to providing food to the children. LPAs also observed whole milk in the fridge which expires on 01/18/2025. LPAs observed infant formula and advised to label it with child's name. The bathroom in the home are clean, sanitary, and operable. The licensee has a working telephone in the facility. LPAs observed a storage area that had a play yard with a baby walker inside. LPAs reminded that baby bouncers and walkers should be placed in an off limit area during hours of operation.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jaime Gonzales
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
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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: CRUZ, GUADALUPE
FACILITY NUMBER: 430757125
VISIT DATE: 01/14/2025
NARRATIVE
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Off-limit areas outside of home include: The entire backyard.

Infant Safe Sleep regulations (PIN 20-24-CCP) were discussed with the licensee including the Individual Infant Sleeping Plan (LIC9227). LPAs observed one infant (C1) was swaddled and placed to sleep in a play yard which had loose articles including a pacifier with a clip attachment. LPAs reminded licensee that infants up to 12 months of age should be placed on their back to sleep, that cribs should be free of all loose articles and hanging objects, and that infants should not be swaddled.

LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed licensee 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.

Five children’s files were reviewed during todays inspection and most required documents were present, including Individual Infant Sleep Plan (LIC9227) and sleep check documentation for all infants. Notification of Parents Rights (LIC995A), Identification and Emergency Information (LIC700) and Immunization Records (PM286). C5 was missing the LIC 627.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jaime Gonzales
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
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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: CRUZ, GUADALUPE
FACILITY NUMBER: 430757125
VISIT DATE: 01/14/2025
NARRATIVE
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2 staff files were reviewed. Employee Rights (LIC9052), Criminal Record Statement (LIC508), Statement Acknowledging Requirement to report Child Abuse (LIC9108), and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and statement declining influenza) was on file. There is at least one staff member present with current CPR/First-Aid that expires on 08/10/2026. The licensee and assistant do not have current Mandated Reporter Training and it expired on 09/19/2024. LPAs reminded that training must be renewed by all staff every 2 years.

Supervision of children was discussed with the licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The licensee states that she does not transport any day care children. LPAs reminded licensee that children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

During todays inspection the following documents were copied:
-Fire disaster drill
-Children's Roster

During the exit interview, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.


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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jaime Gonzales
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
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: CRUZ, GUADALUPE
FACILITY NUMBER: 430757125
VISIT DATE: 01/14/2025
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

As a result of todays inspection, 2 Type A's, 1 Type B deficiencies and 2 technical violations were cited. Appeal rights were provided.

LPAs informed licensee Guadalupe Cruz that this report dated 01/14/2025 documents 2Type 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.

Also, LPAs informed the licensee to provide a copy of this licensing report dated 01/14/2025 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: Joel Segura
LICENSING EVALUATOR NAME: Jaime Gonzales
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/14/2025 12:12 PM - It Cannot Be Edited


Created By: Jaime Gonzales On 01/14/2025 at 11:12 AM
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: CRUZ, GUADALUPE
FACILITY NUMBER: 430757125

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(b)(1)(A)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects. (1) Pacifiers shall be allowed in the crib or play yard if the following provisions are in place: (A) There shall not be anything attached to the pacifier.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPAs observed one infant (C1) swaddled and placed to sleep in a play yard which had loose articles including a pacifier with a clip attachment.
POC Due Date: 01/15/2025
Plan of Correction
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Licensee to review safe sleep regulations and submit plan of correction due on 01/15/2025.
Type A
Section Cited
CCR
102425(f)
Infant Safe Sleep
An infant shall not be swaddled while in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.LPAs observed one infant (C1) was swaddled and placed to sleep in a play yard.
POC Due Date: 01/15/2025
Plan of Correction
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Licensee to review safe sleep regulations and submit plan of correction due on 01/15/2025.
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:Joel Segura
LICENSING EVALUATOR NAME:Jaime Gonzales
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2025


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Document Has Been Signed on 01/14/2025 12:12 PM - It Cannot Be Edited


Created By: Jaime Gonzales On 01/14/2025 at 11:12 AM
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: CRUZ, GUADALUPE
FACILITY NUMBER: 430757125

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above for herself and 1 assistant which poses a potential health, safety or personal rights risk to persons in care. Licensee and assistant mandated reporter training expired on 09/19/2024.
POC Due Date: 01/28/2025
Plan of Correction
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Licensee and assistant to complete the online training and submit proof to LPA by due date of 01/28/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Joel Segura
LICENSING EVALUATOR NAME:Jaime Gonzales
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2025


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