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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415690
Report Date: 07/15/2021
Date Signed: 07/15/2021 03:08:38 PM

Document Has Been Signed on 07/15/2021 03:08 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GARZONE, ROMINAFACILITY NUMBER:
434415690
ADMINISTRATOR:GARZONE, ROMINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 848-6106
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
07/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Romina GarzoneTIME COMPLETED:
03:15 PM
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Licensing Program Analysts (LPAs) Samantha Yip and Aman Sharma conducted an unannounced Required-1 Year inspection. LPAs met with Licensee Romina Garzone and explained the reason for the inspection. Present during today's inspection were Licensee, her spouse, and 3 daycare children.

There is a board to post required postings. The hours of operation are Monday through Friday 6:30AM to 5:30PM. There is working phone in the home.

LPAs toured the inside and outside of the home with Licensee. The off-limit areas of the home are the master bedroom, bathroom adjacent to the master bedroom, 2 bedrooms, the two closets in the hallway, the left and right side of the yard, and garage. There was no fireplace in the home. The home was observed to be clean. There is sufficient amount of toys for children. All cleaning supplies, disinfectant, and other items that could pose a risk to the children were observed to be inaccessible to children. LPA reminded Licensee that any graters and knives in the sink need to be stored inaccessible. There were no baby walkers observed during today's inspection. LPA discussed with Licensee the safe sleep regulation. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 07/15/2021. Licensee stated that there are no weapons, such as firearms, stored in the home.

The backyard is used and fenced. The play equipment were observed to be in good condition. There were no bodies of water observed during today's inspection.

--------------------CONTINUES ON 809 DATED 07/15/2021 PAGE 2-------------------------------
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2021
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 2
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: GARZONE, ROMINA
FACILITY NUMBER: 434415690
VISIT DATE: 07/15/2021
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--------------------CONTINUATION OF 809 DATED 07/15/2021 PAGE 1-------------------------

Licensee stated that she does not transport children at this time, but understands that children cannot be left alone and unattended in parked vehicles. Licensee also stated she is not providing Incidental Medical Services (IMS).

A copy of the facility roster was obtained. 3 children's files were reviewed. The records reviewed include but not limited to the Emergency Contact Card. LPA reminded Licensee to ensure that all sections of the form are filled out. LPA also observed that C-1 did not have a signed Notification of Parent's Right in file. Licensee stated that she will have C-1's parent sign fill it out and send a copy to Licensing.

Licensee has a valid CPR/1st Aid, which expires on 08/29/2022. Licensee also completed the Mandated Reporter training on 01/18/2021. Immunization records for measles and pertussis are on file.

The adults living in the home are Licensee and her spouse. All adults have cleared criminal record, child abuse index, and TB test. LPA reminded Licensee
of the applicable civil penalties for those adults who have not received fingerprint clearance, 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.

As a result of this inspection, no deficiencies were cited. An exit interview was conducted where this report was discussed and provided to Licensee Romina Garzone. A Notice of Site Visit has been issued and must be posted for 30 days.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
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