434414610-9-30-2021-07-CC-JCRZ-C7CPMJ-20210930112624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414610
Report Date: 09/30/2021
Date Signed: 09/30/2021 11:26:47 AM

Document Has Been Signed on 09/30/2021 11:26 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	PASTRANA, CORINA		FACILITY NUMBER:	434414610
ADMINISTRATOR:	PASTRANA, CORINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 506-2017
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 1	DATE:	09/30/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Corina Pastrana		TIME COMPLETED:	11:50 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Janette Cruz conducted an unannounced Required –1 year annual inspection. LPA informed Licensee the purpose of the visit and were granted access to the home. LPA also observed Licensee's daughter (4 years old) in the home during today's inspection. The Licensee states that she has not had any day care children enrolled in her day care since May, 2020; thus, no day care children were present during today's inspection. Licensee states that she wishes to apply for an inactive child care license status since she does not have any day care children enrolled at this time. LPA explained to Licensee all the conditions on LIC 9211 Request for Inactive Child Care License Status. LPA observed the required postings, including the facility license, near the front entrance of the home. The home has a working telephone (408) 507-2017. Days and hours of operation are Monday - Friday from 7:30AM to 5:00 PM. Adults who reside in the home are the Licensee and Licensee's spouse. They both have clearances for Tuberculosis, and Criminal Background and Child Abuse Index Checks. LPA observed that Licensee completed the First Aid and CPR training with certificate valid until 08/2023. The Licensee has the required vaccinations (MMR, TDap and flu-opt out vaccinations). No children's files were reviewed during today's inspection since there are no day care children enrolled. The Licensee states that a child will be isolated in the living room area if needed to because of illness or communicable disease. Safe sleep updated: LPA discussed the new “Safe Sleep” regulations with Licensee and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to her. REPORT CONTINUED ON FOLLOWING PAGE #2

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PASTRANA, CORINA	FACILITY NUMBER: 434414610
	VISIT DATE: 09/30/2021

NARRATIVE

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LPA reminded the Licensee that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean and orderly with heating and ventilation for safety and comfort.. There are no stairs inside the home. LPA observed that there is no fireplace unit in the home. LPA observed barricaded wall heater. Off limit areas inside the home: 1 master's bedroom with bathroom, 2 bedrooms and garage. Off limit areas outside the home: front yard.

LPA observed a fully charged 3A40BC fire extinguisher and working smoke/carbon monoxide detectors. LPA observed a covered above-ground swimming pool. Licensee states that she plans to remove the pool permanently by next week LPA observed that Licensee has a pet (brown Labrador) kept in a kennel located at the backyard of the home. Licensee states that there are no weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Any poisons are locked in the attached garage inaccessible to the day care children.

A review of staff records on 09/30/21 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
REPORT CONTINUED ON FOLLOWING PAGE #3

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PASTRANA, CORINA	FACILITY NUMBER: 434414610
	VISIT DATE: 09/30/2021

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Supervision of children was discussed with Licensee and she understands that she must be present in the home during day care hours (minimum 80 % of the operating hours of the day care) and ensure that the children are supervised at all times. The Licensee understands her capacity options and that she cannot have more than 14 children in the home at any time without an adult assistant. The Licensee states that the she does not have plans to transport day care children. The Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

LPA conducted an exit interview with the Licensee and no deficiencies were issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED WITHIN 30 DAYS.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

LIC809 (FAS) - (06/04)

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