434416747-10-24-2022-07-CC-SYIP-CKHTZS-20221024151049

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416747
Report Date: 10/24/2022
Date Signed: 10/24/2022 03:10:55 PM

Document Has Been Signed on 10/24/2022 03:10 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:	FERNANDEZ DE HARO, GLADIZ		FACILITY NUMBER:	434416747
ADMINISTRATOR:	FERNANDEZ DE HARO, GLADIZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 710-1870
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	10/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:16 PM
MET WITH:	Gladiz Fernandez De Haro		TIME COMPLETED:	03:15 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	Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Licensee Gladiz Fernandez De Haro and explained the reason for the inspection. Present during today's inspection were Licensee, her daughter, and four children, whom one was infant age. Four school-age children arrived around 2:50PM. There is a board to post required postings, such as license and notification of parent's rights. The hours of operation are Monday through Friday 8AM to 5:30PM. There is working phone in the home. LPA toured the inside and outside of the home. The off-limit areas of the home are the entire upstairs, laundry room, and garage. There are stairs and a fireplace in the home, which are barricaded. Disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible to children. There are equipment and toys for children. 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 off-limit area outside is the left side of the home. LPA observed that there were some gaps between the panels of the fence on the left hand side. Licensee will fix gap in the fence and send proof to licensing. LPA also reminded Licensee to ensure the gate for off-limit area goes from wall to wall. There were no bodies of water observed during today's inspection. --------------------continues on 809 dated 10/24/2022 page 2---------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: FERNANDEZ DE HARO, GLADIZ	FACILITY NUMBER: 434416747
	VISIT DATE: 10/24/2022

NARRATIVE

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-----------------continuation of 809 dated 10/24/2022 page 1---------------------

LPA observed that there was a blanket draped on the side of the play yard. Licensee removed blanket during inspection. LPA checked sleep check log during today's inspection. 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.

Licensee does not provide Incidental Medical Services (IMS). 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

Licensee or her daughter will transport children. Licensee understands that children cannot be left alone and unattended in parked vehicles.

A copy of the facility roster was obtained during today's inspection. The records reviewed include but not limited to parent's rights and immunization records.

-------------------continuation of 809 dated 10/24/2022 page 3---------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: FERNANDEZ DE HARO, GLADIZ	FACILITY NUMBER: 434416747
	VISIT DATE: 10/24/2022

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------------------continuation of 809 dated 10/24/2022 page 2---------------------

Licensee and her daughter's files were reviewed during today's inspection. Licensee and her daughter have valid CPR/1st Aid. Licensee's CPR/1st Aid expires on 11/20/2023 and her daughter's CPR/1st Aid expires on 10/15/2024. Licensee completed the Mandated Reporter training on 01/2021. Her daughter did not have certificate on file. Her daughter started helping with the daycare children on 08/16/2022.

The adults 18 and over living in the home are Licensee and her daughter. Licensee also has one minor children. All adults have cleared fingerprints.
Licensee was reminded that all adults 18 and over living or working in the home, 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 will submit:
- Mandated Reporter training certificate for her daughter by 11/14/2022
- proof of that the gap in fence panel is fixed

As a result of this inspection, a Type B was issued. Exit interview conducted and report was reviewed with Licensee Gladiz Fernandez De Haro. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/24/2022 03:10 PM - It Cannot Be Edited

Created By: Samantha Yip On 10/24/2022 at 02:45 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: FERNANDEZ DE HARO, GLADIZ	FACILITY NUMBER: 434416747
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(b)(3)

(b) Cribs or play yards shall be free from all loose articles and objects. (3) There shall be no objects hanging above or attached to the side of the crib. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, which posed a potential health, safety or personal rights risk to persons in care. LPA observed that there was a blanket draped on the side of the play yard.
	POC Due Date: 10/31/2022
	Plan of Correction
1 2 3 4	Deficiency was corrected during today's inspection. Licensee removed blanket.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Joel Segura

LICENSING EVALUATOR NAME:

Samantha Yip

LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

LIC809 (FAS) - (06/04)

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