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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414610
Report Date: 09/03/2024
Date Signed: 09/03/2024 04:03:42 PM

Document Has Been Signed on 09/03/2024 04:03 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:PASTRANA, CORINAFACILITY NUMBER:
434414610
ADMINISTRATOR/
DIRECTOR:		PASTRANA, CORINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 506-2017
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Corina PastranaTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Mandeep Kaur and Andy Yang conducted an unannounced case management inspection to the home today with the purpose of reactivating the Large family child care home license. LPAs met with Licensee, Corina Pastrana. LPAs observed there were no children in care. License has been inactive since 09/30/2021. The large family child care home will be operating Monday through Thursday from 08:30 AM to 04:30PM to serve children ages 2 years to 7 years old. Licensee and Licensee's husband are the only adults residing in the home with their two minor children.

Application for a Family Child Care Home License (LIC 279) was obtained during today's inspection with the updated hours of operation and ages to be served. Licensee does not plan on obtaining liability insurance for the day care. Licensee understands that parents will need to fill out the Affidavit Regarding Liability Insurance (LIC 282) if she does not plan on obtaining liability insurance for the day care.

Licensee has a valid CPR/1st Aid, which expires on 07/05/2026. Licensee's Mandated Reporter training certificate is on file. Licensee completed Mandated Reporter training on 06/03/2024. LPAs reminded Licensee that the Mandated Reporter training and CPR/1st Aid requires renewal every two years. Licensee
immunization records for TB, measles, pertussis, and influenza are also on file.

Licensee will provide morning and afternoon snacks to the children. Family child day care home has refrigerator, microwave, and storage space for food, Healthy beverages requirements were discussed with licensee.

**Continue on 809-C**
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2024
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: PASTRANA, CORINA
FACILITY NUMBER: 434414610
VISIT DATE: 09/03/2024
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**Continuation from 809**
LPAs toured indoor and outdoor areas of the home with licensee. Offlimit area of the home are: 3 bedrooms(Kids room, office space and Master bedroom) one masterbedroom bathroom and an attached garage. On limits area of the home: Living room area and kitchen. Outdoor backyard area is available to play for the children. LPAs advised the licensee that children need to be supervised at all times.

Licensee was reminded to conduct the fire/disaster drill every 6 months and documented. LPAs observed a fully charged 3A40BC fire extinguisher that was last serviced on August 07, 2024 and working smoke/Carbon monoxide detectors. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. The family child care home is clean. The bathroom is observed to be clean, sanitary, and operable.

There is no bodies of water observed and backyard is fenced.

The home is clean, orderly, including heating and air conditioning, for safety & comfort. The licensee has a
valid phone in the home. There is sufficient toys, supplies, and equipment for the day care children indoors.
Licensee is not going to transport the children.

Licensee states that she has a pet (dog) and no weapons/ammunition in the home. Fire clearance for the home was approved on 08/29/20216 and is on file. There were no baby walkers or bouncers observed in the on-limit areas for the children. Licensee understands that baby walkers or other similar items are not permitted for the children.

Forms of discipline to be used by Licensee: talk to the children and redirecting. Licensee understands that children's personal rights should not be violated; including no corporal punishment. isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed.


**Continue on 809-C**
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
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: PASTRANA, CORINA
FACILITY NUMBER: 434414610
VISIT DATE: 09/03/2024
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**Continuation from 809-C**

Licensee states that she may administer medication once she has children in care. Licensee states that a
child will be isolated in dinning area with the supervision if necessary due to illness or communicable disease. Licensee has a First Aid kit with a touchless thermometer 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 (American Disability Act) was provided: US Department of Justice (USDOJ) toll-free ADA
Information Line at (800) 514-0301 (voice) or (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.

LPA reviewed with licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes,
children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the Licensee.

All adults have cleared criminal record clearance, child abuse index, and TB. Applicant was reminded that all
adults 18 and over living in the home, persons who provide care and supervision to children, and staff who
have contact with children, 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.

On this date, 09/03/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

**Continue on 809-C**
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
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: PASTRANA, CORINA
FACILITY NUMBER: 434414610
VISIT DATE: 09/03/2024
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**Continuation from 809-C**

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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and
stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other
important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information
website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child
Care option to receive email communication.

Exit interview conducted and report was reviewed with Licensee, Corina Pastrana. LPAs advised Licensee that Large Family Child Care Home license with the maximum capacity of 14 children, will be issued upon
completion of the following:

1. Licensing Program Manager (LPM) review and approval.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
LIC809 (FAS) - (06/04)
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