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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413380
Report Date: 11/14/2024
Date Signed: 11/19/2024 08:35:46 AM

Document Has Been Signed on 11/19/2024 08:35 AM - 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:FUSHIKI, MARIAFACILITY NUMBER:
434413380
ADMINISTRATOR/
DIRECTOR:		FUSHIKI, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 390-3435
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 10DATE:
11/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:42 AM
MET WITH:Claudia AlbornozTIME VISIT/
INSPECTION COMPLETED:
03:18 PM
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Licensing Program Analysts (LPAs) Mandeep Kaur and Syhshyan "Shine" Yu conducted an unannounced annual inspection. LPAs met with Assistant, Claudia Albornoz and explained the reason for the inspection. Licensee, Maria Fushiki was not present during inspection. Present during today's inspection were 10 children with three assistants.

The hours of operation are Monday through Friday 08:30AM to 5:30PM. There is a board to post required postings, such as license and notification of parent's rights.

LPAs toured the inside and outside of the home with Assistant. Onlimit areas: Dining Room, Family Room, and a restroom in the Family Room on the first floor. Off Limit Areas are the garage and the entire second floor. Disinfectant and cleaning supplies were inaccessible to children. LPAs reminded Licensee that anything sharp or states to keep out of reach of children, such as blades or razors need to be inaccessible.
There are toys and equipment for children. There is a fully charged fire extinguisher, smoke detector, and
carbon monoxide detector. The last fire/disaster drill was conducted on 09/27/2024. Assistant stated that there are no weapons, such as firearm, stored in the home. There are pets in the home: 2 gunnie pigs, two cats, and two dogs.

The backyard is available for the children with age appropriate toys and equipment. Assistant stated that day care children do not use trampoline in the backyard. LPAs observed the trampoline area in backyard was enclosed with fencing to keep it inaccessible to children.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep
webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. 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.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: FUSHIKI, MARIA
FACILITY NUMBER: 434413380
VISIT DATE: 11/14/2024
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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/.

A copy of the facility roster was obtained. Five (5)children's files were reviewed during today's inspection. The records reviewed include but not limited to immunization records and notification of parent's rights. LPAs also reviewed sleep log and the LIC 9227.

Licensee's and three (3) staff files were reviewed during today's inspection. The records reviewed include but not limited to immunization records, mandated reporter training including CPR/1st aid certifications.

Licensee completed the Mandated Reporter training on 05/26/2023. Licensee has a valid CPR/1st Aid, which
expires on 01/2026.

Healthy beverages requirements were discussed.

The adults 18 and over living in the home are Licensee and her two adult children. All adults have cleared
criminal record and child abuse index. 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.

Assistant 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.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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: FUSHIKI, MARIA
FACILITY NUMBER: 434413380
VISIT DATE: 11/14/2024
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During the exit interview, assistant, Claudia Albornoz confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiency issued during today's inspection.

At 12:08PM, LPA, Kaur interviewed Licensee, Maria Fushiki over the phone and licensee authorized Assistant, Claudia Albornoz to sign the report on behalf of licensee.

Exit interview conducted and report was reviewed with Assistant, Claudia Albornoz. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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