434416386-9-26-2022-07-CC-PHEZ-CJMQP2-20220926122001

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416386
Report Date: 09/26/2022
Date Signed: 09/26/2022 12:20:08 PM

Document Has Been Signed on 09/26/2022 12:20 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	PIMSAKUL, MATHWEE & KENDRA		FACILITY NUMBER:	434416386
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 7	DATE:	09/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:17 AM
MET WITH:	Kendra Pimaskul		TIME COMPLETED:	12:40 PM

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	On 9/26/2022: Licensing Program Analyst (LPA) Pete Hernandez met with Licensee, Mathwee and Kendra Pimaskul and conducted an unannounced combination Required 1 year and capacity increase to a large FCCH inspection. The adults that reside in the home are: the two Licensees'. Licensees have 4 minor school-age children under 10 years of age. LPA observed 3 infants and 4 preschoolers in care, Licensees provide respite care and are foster parents through Santa Clara County. Licensee's currently do not have foster care children living in the home. Santa Clara County Resource Family number: 999637RFA. Days and hours of operation will be Monday - Friday from 7:00AM to 6:00 PM. CPR and First Aid certifications are current with an expiration date of 5/21/2023. Licensees rent the home. Carry Liability Insurance for the day-care. LPA toured the indoor and outdoor areas. The home is clean and orderly. Off limit areas in the home garage. The gated backyard is on-limits and area outside the home excluding shed and trampoline. LPA observed a fully charged 2A10BC fire extinguisher, working smoke detector, fire pull stations ,functioning carbon monoxide detector, two barricaded fire places in the living and family room, fenced backyard, and no bodies of water. LPA observed sufficient materials, toys, and play equipment for the daycare children. Per Licensee, there are no weapons in the home. Licensee's have one fully vaccinated dog. LPA reminded Licensees that smoking, baby walkers, bouncers, jumpers, and similar items are in Family Child Care Homes. Property Owner/Landlord Consent (LIC 9149) and Property Owner/Landlord Notification (LIC 9151) are on file. Licensees state that they will use positive discipline and redirection as forms of discipline. Applicants understand that children's personal rights should not be violated; including no corporal punishment. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 09/26/2022:

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PIMSAKUL, MATHWEE & KENDRA	FACILITY NUMBER: 434416386
	VISIT DATE: 09/26/2022

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 9/26/2022):

LPA informed 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

The Licensee states that she does not transport children and understands that children cannot be left in parked vehicles unattended at any time. Licensee understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick child, requirements for reporting suspected child abuse, unusual incidents/injuries, heat-related illnesses, and requirements for assistant/substitute were also discussed.

Supervision of children was discussed with the Licensee. Licensee understands that she must be present in the home at least 80 percent of the hours the day care is in operation and ensure that the children are supervised at all times. The Licensee understands her capacity options. The Licensee states that she does not transport children and understands that children cannot be left in parked vehicles unattended at any time. Licensee understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick child, requirements for reporting suspected child abuse, unusual incidents/injuries, heat-related illnesses, and requirements for assistant/substitute were also discussed.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PIMSAKUL, MATHWEE & KENDRA	FACILITY NUMBER: 434416386
	VISIT DATE: 09/26/2022

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Last fire drill was done 9/15/22. LPA informed Licensee that fire/disaster drills must be practiced at least once every six months and documented. Licensee's currently hold fire drills every month.

Both Licensees Mandated Reporter certificates expire 9/24/24.

LPA discussed the Individual Infant Sleep Plan 9227 with the Licensee's. They currently use them.

LPA went over Reg 102425(j) and (j)(2)(D) regarding infant care and LIC 9227 (Infant Sleeping Plan). LPA Provided a copy. The provider shall supervise infants while they are sleeping.

Licensee's understamd that the capacity increase to a large FCCH is subject to managemwent approval.

LPA observed all required postings on the wall next to the front door.

TYPE A language: Should there ever be issuance of Type A citations today, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

Deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. A copy of this report and appeals rights were discussed and left with the Licensee, Kendra Pimsakul, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

LIC809 (FAS) - (06/04)

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