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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417281
Report Date: 07/27/2022
Date Signed: 07/27/2022 02:46:38 PM

Document Has Been Signed on 07/27/2022 02:46 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:ABESAMIS, MONICA & ALLENFACILITY NUMBER:
434417281
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/27/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:Monica Abelardo AbesamisTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Stephanie Collins conducted an announced, scheduled Pre-Licensing inspection at 25 Birch Lane San Jose CA. 95127 LPA met with Applicant Monica Abelardo Abesamis . Applicant is applying for a license to operate a Small Family Child Care Home with a maximum capacity of (8) eight at the address listed above.

During the inspection the applicants husband( Allen Taburada Abesamis ) the son was present. The applicant resides in the home with her husband, son and friend Jerome Bautista De Joya. A copy of the control of property is on file. LPA observed that the home has a fully charged 2A:10BC fire extinguisher. Smoke and carbon monoxide detectors were tested and proved to be functioning. The home’s disaster plan of action was discussed along with the requirement for the home to conduct and document fire and disaster drills at least once every six months. LPA reminded Applicant that smoking is not allowed in family childcare homes and baby walkers shall not be allowed on the premises of the family childcare home in accordance with Health and Safety Code Section 1596.846(b) and (c).

Days and hours of operation will be Monday through Friday 7:00 AM to 6:00 PM. Applicant has completed 16 hours of training on preventive health practices with Lead, which included pediatric cardiopulmonary resuscitation and pediatric first aid, and one hour on Child Care Nutrition. Applicant's Pediatric and CPR certification expires 7/242024. Applicant has documented proof of immunity against Measles and Pertussis. The applicant's proof of completion of the AB1207 Mandated Reporter Training was completed on 6/15/2022.

Adults who are over the age of 18 and reside in the home are the Applicant and Applicant's Spouse (Allen Taburada Abesamis) and friend (Jerome Bautista De Joya). Both Applicant and spouse have clearances for Criminal Record, Child Abuse Index Background Check and Tuberculosis.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2022
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 4
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: ABESAMIS, MONICA & ALLEN
FACILITY NUMBER: 434417281
VISIT DATE: 07/27/2022
NARRATIVE
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LPA reminded Applicant Monica about the applicable civil penalties for those adults who have not received fingerprint clearances, who are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.
LPA inspected the indoor and outdoor areas of the home. Off limits areas in the home are Three (3) Bedrooms, kitchen and garage area. The home a fully fence- in backyard for outdoor activity. Off-limit area in back yard the sides of house, the outdoor accessory unit (small structure) and storage unit. LPA observed appropriate children’s play structure and toys. Applicant Monica states the children will be supervised at all times during outside activities. No bodies of water observed.
The home is clean and orderly, with heating and ventilation for safety and comfort of children in care. Applicant Monica states that there are no weapons such as firearms stored on the premises. Detergents, cleaning compounds, sharps, medicines, and other items which could pose a danger if readily available to children were stored where they are inaccessible, out of reach of children. LPA reminded Applicant that poisons need to be locked-up and stored inaccessible to children. LPA reminded Applicant Monica baby walkers, and such are not permitted in a Licensed Family Care Home.

Applicant stated that the form of discipline to be used are talking and redirecting the children. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Applicants stated that she understands that the children have personal rights that cannot be waived or abridged regardless of consent or authorization from the child’s authorized representative. LPA went over the records that need to be maintained at the home with Applicant.
Applicant is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of Laws, etc.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: ABESAMIS, MONICA & ALLEN
FACILITY NUMBER: 434417281
VISIT DATE: 07/27/2022
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LPA informed Applicant that if she decides to not carry liability insurance for the Family Day Care, she will have to maintain in children’s file an affidavit regarding liability insurance signed by each parent of the children that will be enrolled. LPA reviewed with Applicant the violations that would result in an immediate assessment of civil penalty in the amount of $500.
PA also discussed with the Applicant Monica about the continuing requirements, which include but are not limited to the following topics: (1) Separating sick children when they show signs of illness; (2) Supervision of Children; (3) Capacity Options; (4) transportation of children; (5) Procedures for Reporting Suspected Child Abuse and Unusual Incidents/Injuries; LPA reviewed with applicant, Monica 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.
LPA discussed the safe sleep regulations with applicant/Priscilla 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 Applicant Monica 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.
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 platform.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: ABESAMIS, MONICA & ALLEN
FACILITY NUMBER: 434417281
VISIT DATE: 07/27/2022
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Exit interview conducted and report was reviewed with the Applicant Monica Abelando Abesamis .

Based on today's inspection, LPA determined that the home is following applicable Health & Safety Code and Title 22 Regulations.

Therefore, Applicant was informed that Applicant's file will be submitted to Licensing Management for final review and approval.

Pending Documents
Request for Live scan Service (LIC 9163) for: Jerome De Joya
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4