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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415518
Report Date: 12/12/2024
Date Signed: 12/12/2024 04:12:02 PM

Document Has Been Signed on 12/12/2024 04:12 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:FUENTES CANO, ANAFACILITY NUMBER:
434415518
ADMINISTRATOR/
DIRECTOR:		FUENTES CANO, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 981-7161
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
12/12/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Ana Fuentes CanoTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On December 12, 2024, at 2:10 PM, Licensing Program Analyst's (LPA) Elimika Woods and Angela Luz met with licensee Ana Fuentes Cano for an Unannounced 3 Year Required Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection was the licensee's fingerprint cleared assistant's and husband. All adults subject to criminal background review have obtained criminal record clearance. There are were thirteen children present during today’s inspection, three infants, five preschool age children and five school age children. The licensee stated that the facility operates from Monday to Friday 6:00 PM to 6:00 PM.

LPA toured the facility inside and out to conduct a Health and Safety inspection. This single-story home consists of three bedrooms, office, two baths, a living and dining room, kitchen, backyard and attached two car garage. This home was clean and orderly, with (centralized) heating and ventilation for the safety and comfort.

The off-limits will be made inaccessible by closed and/or locked doors and visual supervision. There's a gate at bedroom 3 entrance to prevent children access when no staff is in the room. LPA checked the cabinets in the on limit areas which includes the kitchen, bathroom, bedrooms, and any other cabinets or drawers accessible to children in care and did not observe any hazardous materials or toxins accessible to children during today’s inspection. At 2:35 PM, LPA inspected the backyard area to make sure that there are no pools, hot tubs or any other bodies of water present that violates the childcare licensing laws and there were none, during today's inspection.

On- Limit areas are the: Family room, kitchen, bedroom (3) next to kitchen, backyard, hallway bathroom, and office
Off- Limit areas are the: Bedroom (1) straight down the hallway, bedroom (2) on right side of hallway, storage shed in backyard and garage.

LPA tested the smoke detector in the hallway and the carbon monoxide detector in the family room and found them to be functioning properly. The facility has a fully charged 3A40BC fire extinguisher which meets standards established by the State Fire Marshal in the kitchen. The facility also has a pull down fire alarm system, a working telephone and a first aid kit that she keeps in a basket in the hallway. The Isolation area of the home will be bedroom (3), away from other children in care.

See 809-C for continuance.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: FUENTES CANO, ANA
FACILITY NUMBER: 434415518
VISIT DATE: 12/12/2024
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 This home has a fireplace that has a barricade/screen to prevent access by children in the family room. LPA asked the licensee does she transports children and the licensee stated that she does transport children and provided LPA a copy of her California's Driver's License. During the record review LPA Woods checked the Health Records of the licensee, staff, and children and found that the licensee is following the immunization laws which pertain to all childcare providers.

The Backyard area is the fully fenced backyard and LPA observed that it is free from defects or dangerous conditions. During today's inspection, there a large play structure with swings and a slide that’s anchored to the ground with cushioning underneath to absorb children falls. There are ample age-appropriate toys that appear to be safe and in good condition. There's a shed with a lock to prevent children access to equipment in the backyard.

At 2:45 PM, LPA requested and reviewed the files of four (4) children in care and three (3) staff files. All children’s files contain Immunization, Identification & Emergency Information, Parent's Rights, and Medical Consent forms and the staff file has the required Employee Rights and Health Screening forms. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted 09/06/24. The licensee's Health and Safety training is completed, and CPR and First Aid certificate is current and expires on 8/2026. The licensee has completed mandated reporter training on 09/24/24. Per licensee there are no weapons of any kind in the home. The licensee is in ratio today. All required forms are posted and visible for public review.

Effective August 1, 2003, California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email [email protected] to be included in the Child Care Quarterly Updates distribution list. The licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers")5 is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.



See 809-C for continuance.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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: FUENTES CANO, ANA
FACILITY NUMBER: 434415518
VISIT DATE: 12/12/2024
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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-andresources/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 was reminded that all adults 18 and over living or working in the home, 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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

The licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Ana Fuentes Cano, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Ana Fuentes Cano.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC809 (FAS) - (06/04)
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