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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407748
Report Date: 11/30/2022
Date Signed: 11/30/2022 12:11:30 PM

Document Has Been Signed on 11/30/2022 12:11 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BACANI, SOLEDAD & DIAZ, CRISTINAFACILITY NUMBER:
434407748
ADMINISTRATOR:S BACANI/C DIAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 254-4870
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
11/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Soledad Bacani TIME COMPLETED:
11:55 AM
NARRATIVE
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Licensing Program Analyst (LPA), Stephanie Collins, conducted an unannounced annual inspection of the. LPA met with Licensee Soledad Bacani and informed her the purpose of the visit to conduct an Annual Inspection.

LPA arrived at the facility at 8:45 AM, Notification of Parents’ Right Poster, Child Care License, LIC 610 Emergency Disaster Form (1and 2), and menu were observed to be posted. Facility’s operating days and hours are Monday-Friday 07:30 AM to 06:00 PM.

During visit, LPA observed 5 children, the licensee and assistant Ariene Ang Huertas.
Residing in the home is Licensee, and two renter Carreon Grace and Anselma Callejo
Licensee states her Niece Jennifer B Cardneas and her two minor children are visiting from out of the country for the ten next ten days. Jennifer B Cardenas has proof of DOJ background check completed.

Licensee Soledad Bacani was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.


LPA inspected the home inside and out with licensee Soledad . The home has a functioning carbon monoxide, Smoke detector and fully charged fire (3-A-40-BC).
Medication, cleaning products and similar items that can pose a danger to children if readily accessible are stored inaccessible to children. LPA reviewed the facility's roster and obtained a copy. Fire and disaster drills were last conducted and recorded on 11/22/2022.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BACANI, SOLEDAD & DIAZ, CRISTINA
FACILITY NUMBER: 434407748
VISIT DATE: 11/30/2022
NARRATIVE
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Off limits areas: The Converted garage (used for storage) and all four bedrooms and kitchen area . The backyard is fenced and is used for outdoor activities. Off limit areas are around the locked storage shed. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. There were no bodies of water observed. Director stated that facility does not have weapons on the premises.
Floors were clean. Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. LPA observed that food storage areas were clean, free of litter, rubbish, and rodents/vermin. Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on.
Children and Personnel Record /files was reviewed: Children records reviewed included: Identification and Emergency Information, Consent for Emergency Medical Treatment form, Notification of Parents Rights, Affidavit Regarding Liability Insurance and immunization.

Staff records reviewed include: Criminal Record and Child Abuse Index Background Check Clearance, Health Screening Report with TB Clearance, Immunization Record for Measles and Pertussis, Education Qualification, and required Training. LPA reminded Director that the AB1207 Mandated Reporter Training needs to be renewed every two years. There was at least one person with documented current certification in Pediatric CPR/1st Aid present at the facility during LPA' inspection.
Safe Sleep
LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] 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
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
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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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BACANI, SOLEDAD & DIAZ, CRISTINA
FACILITY NUMBER: 434407748
VISIT DATE: 11/30/2022
NARRATIVE
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Notice of Site Visit
A notice of site visit was given and must remain posted for 30 days.


Posting Requirements
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Deficiencies were observed during this inspection and be review on attached D page.





Exit Interview
Exit interview conducted and report was reviewed with the licensee Soledad Bacani
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/30/2022 12:11 PM - It Cannot Be Edited


Created By: Stephanie Collins On 11/30/2022 at 11:24 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: BACANI, SOLEDAD & DIAZ, CRISTINA
FACILITY NUMBER: 434407748

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2022

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 record review, the licensee did not comply with the section cited above in [1] out of [1] [Licensee Bacani Soledad] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/02/2022
Plan of Correction
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Licensee agreed to submit proof of current Mandated Reporter Training on or before POC date
1: Licensee- Bacani, Soledad
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/02/2022
Plan of Correction
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Licensee agreed to submit proof on immunization (Measles) for Assistant.
1: Arlene Ang Huerta ent is not met as evidenced by:
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:Gladys Kuizon
LICENSING EVALUATOR NAME:Stephanie Collins
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022


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