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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416747
Report Date: 05/11/2022
Date Signed: 05/12/2022 11:58:49 AM

Document Has Been Signed on 05/12/2022 11:58 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:FERNANDEZ DE HARO, GLADIZFACILITY NUMBER:
434416747
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
05/11/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Gladiz Fernandez De HaroTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management- Licensee Initiated inspection. LPA met with Licensee Gladiz Fernandez De Haro and explained the reason for the inspection. The purpose of this inspection is Licensee applied for a large Family Child Care Home (FCCH). Licensee has been licensed since 08/04/2017 and therefore has at least one year of experience to apply for a large FCCH. A fire clearance was granted on 05/06/2022. Present during today's inspection were Licensee and three children, whom one was infant age.

There is board to post required postings, such as license, emergency disaster plan, and notification of parent's right. The hours of operation are Monday through Friday 8AM to 5:30PM. There is working phone in the home. Licensee owns the home.

LPA toured in the inside and outside of the home. The off-limit areas inside of the home are the laundry room, garage, and the entire upstairs. There is a fireplace and stairs in the home, which are barricaded. Disinfectant, cleaning supplies, and other items that are dangerous to children were observed to be inaccessible. Equipment and toys were age appropriate and in good condition. There is a playyard. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Licensee stated that there are no weapons, such as firearms, stored in the home.

The backyard is used and is fenced. The right side of the yard is off-limits. The toys were observed to be in good condition. There were no bodies of water observed during today's inspection.

---------------------------continues on 809 dated 05/11/2022 page 2---------------------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2022
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 3
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: FERNANDEZ DE HARO, GLADIZ
FACILITY NUMBER: 434416747
VISIT DATE: 05/11/2022
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-------------------------continuation of 809 dated 05/11/2022 page 1--------------------------------

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee 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.


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)/ (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 discussed with Licensee about the maximum capacity requirement of a Large Family Child Care Home License. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home shall be either:
(1) 12 children, no more than four of whom may be infants; or
(2) more than 12 and up to 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age and there are no more than three infants being cared for during any time when more than 12 children are being cared for.

--------------------------continues on 809 dated 05/11/2022 page 3------------------------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: FERNANDEZ DE HARO, GLADIZ
FACILITY NUMBER: 434416747
VISIT DATE: 05/11/2022
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When Licensee have more than 12 and up to 14 children in the home, Licensee must notify the parent using the form LIC9150 “Parent Notification Additional Children in Care." LPA reminded Licensee that when Licensee does not have a Helper, Licensee can only care for up to 8 children at any one time in the home. Licensee stated that her daughter is going to be helping her with the daycare children.

Licensee has a valid CPR/1st Aid, which expires on 11/20/2023. Licensee completed Mandated Reporter training on 01/17/2022. Immunization records for measles, pertussis, and influenza are on file.

The adults 18 years and older living in the home are Licensee and her adult daughter. Licensee also has one minor child. All adults have cleared criminal record, child abuse index, and TB clearance. Licensee 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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee stated that she will submit an updated LIC 279 to reflect the changes to the hours of operation.

As a result of this inspection, no deficiencies were issued. Exit interview conducted and report was reviewed with the Licensee Gladiz Fernandez De Haro. Licensee was informed that upon receipt of Licensing Management's approval, a license for a Large Family Child Care Home will be granted and issued to Licensee.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
LIC809 (FAS) - (06/04)
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