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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412942
Report Date: 11/20/2024
Date Signed: 11/20/2024 04:04:21 PM

Document Has Been Signed on 11/20/2024 04:04 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:LOPEZ, AMALIAFACILITY NUMBER:
434412942
ADMINISTRATOR/
DIRECTOR:		LOPEZ, AMALIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 420-2646
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
11/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Amalia LopezTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual inspection to the home today. LPA met with Amalia Lopez, Licensee and explained, the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 06:00 AM to 5:00 PM. The adults that reside in the home are the Licensee, her spouse Juan Carlos, and her adult sons Juan and Adrian. Also in the home reside licensee's minor children ages 15 and 8 years old. There were nine children in care during today's inspection, including three infants and six preschool age children. Licensee's helper Maria Estela Calixtro was also present and supervising the children in care. Certification for CPR and First Aid Card for Licensee and her helper Maria are current and will expire on 9/2/25 and 7/19/26 respectively.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA took a picture of the children's roster today and it is current. LPA observed that Licensee has documented a fire drill on 10/24/24. LPA reviewed five children files.
The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. LPA observed the day care area is located to the right side of the home in two different rooms. Off limit areas inside are: Three bedrooms and one bathroom. The laundry area is located in a closet in the hallway and detergents are stored high on a cabinet. LPA observed the day care area has a bathroom for use by the children. Off limits areas outside: The left side yard, the storage shed in the back yard, and the car port to the right front yard. LPA has observed home has a back yard and it is fenced and used as a play yard. Licensee stated she has an small dog that she keeps in one of the off limits bedroom and it is vaccinated. LPA observed no bodies of water, stairs or wall heaters.

LPA observed a fully charged 3A40BC fire extinguisher last time serviced on 6/11/24 and at least one working smoke/carbon monoxide detector. Licensee states that there are no weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.
According with the SB792, Licensee has presented proof that she has immunization for herself and for helper for measles, pertussis and influenza.

Report dated 11/20/24 continues in page 2.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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: LOPEZ, AMALIA
FACILITY NUMBER: 434412942
VISIT DATE: 11/20/2024
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Report dated 11/20/24 continues from page 1.

Supervision of children was discussed with Licensee and she understands that she or qualified helpers must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands the capacity options and she understands that she cannot have more than 14 children in the home at any time and a helper must be present. Licensee understands in absence of a helper her license is reduced in capacity and ratio (age of the children) to a small Family Child Care Home license (maximum 8). Licensee states that they do not transport children via vehicle and that he understands that children cannot be left in parked vehicles unattended at any time.
Department website: www.ccld.ca.gov provided to Licensee.

LPA observed that Licensee and her helper have renewed the "Mandated Reporter" training on 3/24/24. Licensee understands the training must be renewed every two years. LPA referred the Licensee to the Department website: www.mandatedreporterca.com for additional information on the online training.

A review of staff records on 11/19/24 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 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.

LPA discussed the safe sleep regulations with licensee 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.

Report dated 11/20/24 continues on page 3.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
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: LOPEZ, AMALIA
FACILITY NUMBER: 434412942
VISIT DATE: 11/20/2024
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Report dated 11/20/24 continuers from page 2.

LPA 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.

Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Licensee was informed of the www.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.

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

Exit interview conducted and report was reviewed with the licensee Amalia Lopez.

No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC809 (FAS) - (06/04)
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