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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415836
Report Date: 06/22/2021
Date Signed: 06/22/2021 02:50:51 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/22/2021 02:50 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:QUINTERO, LIZ ANDREAFACILITY NUMBER:
434415836
ADMINISTRATOR:QUINTERO, LIZ ANDREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 575-1774
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 14DATE:
06/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Liz Andrea QuinteroTIME COMPLETED:
01:20 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Fermin Campos-Jaramillo and Ofelia Calivo met with Liz Andrea Quintero, Licensee, for unannounced Required – 1 year annual inspection. LPAs were granted access to the home by the Licensee. LPAs also observed two infants, eleven preschoolers and one school age child (Licensee’s child) during today's inspection. The Licensee was not operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the home. The home has a working telephone. Days and hours of operation are Monday - Friday from 7:30 AM to 5:30 PM. The Licensee and her spouse are the adults residing in the home. Present in the home today was the licensee, her spouse Carlos, her helpers Natalia and Claudia, and her friend Viviana. Licensee's CPR and First Aid are current and expire on September 25, 2021. The Licensee's adult assistants: Claudia Parra’s CPR & First Aid certifications are current and expire on January 25, 2022. Natalia Franco’s CPR & First Aid are current and expire November 5, 2022. Upon arriving to the home, an adult (Viviana Maldonado) attended the door. LPAs noticed that Viviana is not listed as one of the adults who have received Criminal Records or exemptions. Civil penalties for $100.00 were assessed today.
LPAs reviewed and obtained a copy of the Child Care Facility Roster. Licensee has documented a Fire/Disaster drill on April 21, 2021. The Licensee and her helpers have the required immunization (MMR, Tdap, & flu) and have completed the Mandated Reporter Training for Child Care Workers. LPAs reviewed thirteen children's files and observed current and updated Identification and Emergency Information (LIC 700) and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. The Licensee does not have a file for her son. The Licensee states that a child will be isolated in the living room couch if needed to because of illness or communicable disease.
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SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Ofelia Calivo
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: QUINTERO, LIZ ANDREA
FACILITY NUMBER: 434415836
VISIT DATE: 06/22/2021
NARRATIVE
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Report continues from page 1
Safe sleep update: LPA discussed the new “Safe Sleep” regulations with the Licensee and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensee. 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. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. There are no stairs inside the home and the fireplace is blocked with a cabinet. Off limit areas inside the home: master bedroom, Licensee’s office, and the attached garage. Off limit areas outside the home: left and right side yards.

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. The Licensee states that she does not have any pets and weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Any poisons are locked and inaccessible to the day care children. The Licensee states that she does not administer any medication to the day care children at this time.

A review of staff records on June 21, 2021 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 the 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 continues on page 3
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Ofelia Calivo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
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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: QUINTERO, LIZ ANDREA
FACILITY NUMBER: 434415836
VISIT DATE: 06/22/2021
NARRATIVE
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Report continues from page 2

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time without a fully qualified adult present. The Licensee states that does not transport any 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.

LPA discussed the requirements of AB 633 with the Licensee and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and the Licensee understands the requirements. LPA also discussed "zero tolerance" related regulations with the Licensee and advised her of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

2 Type A deficiencies were cited today.

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

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Ofelia Calivo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/22/2021 02:50 PM - It Cannot Be Edited


Created By: Ofelia Calivo On 06/22/2021 at 12:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: QUINTERO, LIZ ANDREA
FACILITY NUMBER: 434415836

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/23/2021
Section Cited
CCR
102416(d)(1)

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d) Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance or a criminal
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Licensee shall read regulations and will submit a statement by the Plan Of Corrections (POC) date that she understands the regulations and will avoid this deficiency to repeat. AB633 Parent Notification is required. This report shall be provided to all parents of children currently enrolled and any future children being enrolled for
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record exemption as required by law or Department regulations. This regulation was not met as evidenced by: At LPAs Arrival and uncleared adult (Viviana Maldonado) attended the door. This poses an immediate risk to the children in care.
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the next 12 months per AB633 requirements.
Licensee was advised to obtain signature on form LIC9224 (form was provided to Director) from each child’s parent or representative that they have received a copy of this report.
Type A
06/23/2021
Section Cited
CCR102416.5(d)(2)

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(d) For a Large Family Child Care Home, the maximum number of children ...including children under age 10 who reside at the licensee's home and the assistant... (2) More than twelve and up to fourteen children only if the
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Licensee shall read regulations and will submit a statement by the POC that she has read the regulations and she has corrected this deficiency and that she will avoid this deficiency to repeat. AB633 Parent Notification is required.
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 criteria in Section 1597.465 of the Health and Safety Code are met. This requirement was not met as evidenced by:LPAs observed 14 children in care and only licensee's 6 years old child was a school age child.
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Licensee was advised to obtain signature on form LIC9224 (form was provided to Director) from each child’s parent or representative that they have received a copy of this report.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Diana Stephenson
LICENSING EVALUATOR NAME:Ofelia Calivo
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2021


LIC809 (FAS) - (06/04)
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