434416583-7-30-2024-07-CC-MSMS-D7NNYE-20240730105238

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416583
Report Date: 07/30/2024
Date Signed: 07/30/2024 10:52:43 AM

Document Has Been Signed on 07/30/2024 10:52 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	OLIVEIRA MENEZES, MARA HENDRIELLE		FACILITY NUMBER:	434416583
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 1	DATE:	07/30/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Mara Hendrielle Oliveira Menezes		TIME VISIT/ INSPECTION COMPLETED:	11:15 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) Mel Matos met with Mara Hendrielle Oliveira Menezes, Applicant, to conduct an announced prelicensing inspection at 25 Rio Robles E #118, San Jose, CA 95134. LPA notes that the Applicant resides in the North Park Apartment Home complex facing Baypointe Drive (1st floor). Public parking is available on Baypointe Drive. LPA was granted access to the home by the Applicant. Applicant and her adult friend were the adults present in the home during today's inspection. The Applicant is the only adult residing in the home. Applicant has one minor child, ages 3 years of age residing in the home. Days and hours of operation will be Monday - Friday from 8:00 AM to 5:00 PM. Applicant completed her Preventative Health and Safety Training on 10/2/2022 and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 10/01/2024. Applicant completed the Mandated Reporter Training for Child Care Workers on 10/03/2022 and a copy of the certification is on file. A copy of current TB test, Mmr, Tdap, and flu (opt out) vaccinations for the Applicant are on file. Because the Applicant rents/leases the home, proof of landlord notification is required. LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the Applicant confirms was provided to the property owner/landlord. Applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Copies of both documents are on file. Applicant provided proof of control of property to the Department prior to today’s inspection and a copy of the lease agreement is on file. Applicant does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) to all enrolling families unless she obtains liability insurance in the future. LPA toured the indoor and outdoor areas of the home with the Applicant during today's inspection. There are no stairs, fireplace or wall heater units inside the home. Off limit areas inside the home: one bedroom, one bathroom, and kitchen area. Off limit area outside the home: front entrance area. Applicant states that the children will utilize the outdoor patio area, located adjacent to the living/dining room, under direct supervision. The home is clean, orderly, including heating/air conditioning, ventilation, for safety & comfort. The Applicant has a valid phone in the home (#650-722-4823). There are sufficient toys, supplies, and equipment for the day care children both indoors/outdoors.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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: OLIVEIRA MENEZES, MARA HENDRIELLE	FACILITY NUMBER: 434416583
	VISIT DATE: 07/30/2024

NARRATIVE

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LPA observed a fully charged fire extinguisher (2A10BC), working combo smoke & carbon monoxide detectors, and fenced patio area. There is a swimming pool within the complex that is adequately fenced with a self-latching gate. Applicant states that the swimming pool is only for residents of the complex. Applicant states that she does not have any pets or weapons/ammunition in the home. Applicant states that all food brought from home will be labeled with each child's name and properly stored. Applicant states that nobody smokes and she understands that smoking is prohibited in the home.

Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. Applicant states that there are no poisons in the home. LPA reminded Applicant that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. Applicant states that a child will be isolated in the one of the bedrooms if necessary due to illness or communicable disease. Applicant has a First Aid kit with a touchless thermometer in the home.

Forms of discipline to be used by Applicant: positive discipline/talking to children. Applicant 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. LPA informed the Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

Applicant states that she will not administer any medication to the children at this time. 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 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.

Mara Hendrielle Oliveira Menezes, 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.

LPA reviewed with Mara Hendrielle Oliveira Menezes, Applicant, 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.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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: OLIVEIRA MENEZES, MARA HENDRIELLE	FACILITY NUMBER: 434416583
	VISIT DATE: 07/30/2024

NARRATIVE

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LPA discussed the safe sleep regulations with Mara Hendrielle Oliveira Menezes, Applicant, and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed Mara Hendrielle Oliveira Menezes, Applicant, of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

On this date, 07/23/2024, 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.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care 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-carelicensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicant, Mara Hendrielle Oliveira Menezes. LPA advised the Applicant that a small Family Child Care Home license will be approved effective today, July 30, 2024.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC809 (FAS) - (06/04)

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