RIVERA, ANTONIA

Based on record review, the licensee did not comply with the section cited above. Child 1, 2, 3, 4, 5, 6, 8, 9, 10, and 11 are missing LIC995 which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee will submit LIC995 for child 1, 2, 3, 4, 5, 6, 8, 9, 10, and 11 to CCLD by POC date.

Based on record review, the licensee did not comply with the section cited above. Child 7 is missing LIC627 which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee will submit LIC627 for child 7 to CCLD by POC date.

Based on observation, interview and record review, the licensee did not comply with the section cited above, licensee states Child 1 (C1) has not been immunized, which poses an immediate health, safety or personal rights risk to persons in care.

Resolution: Licensee will terminate unvaccinated child until proof of first round of vaccinations and Doctor note for the next round of vaccinations will be done. Licensee will submit proof of vaccinations and parent and licensee plan to keep vaccinations up to date to the San Jose Regional Office by end of business 10/21/2022.

Based on observation and record review, the licensee did not comply with the section cited above, in on limit area of back yard, unopened beer cans were visible on right side fence, bird cage with food scattered on floor attracting rodents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee cleared one deficiency (unopened beer cans) were disposed in garbage can. Licensee will submit a photo of bird cage area and statement stating bird cage food and dropping will be cleaned up daily to the San Jose Regional Office by end of business 10/05/2022.

Based on observation and record review, the licensee did not comply with the section cited above, licensee assistant Gloria Diaz has not been enrolled or completed Mandated Reporter training, which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee will submit Gloria Diaz's proof of completion of Mandated reporter training to the San Jose Regional Office by close of business 10/05/2022.

Based on observation, the licensee did not comply with the section cited above, licensee had shampoo and medicine accessible to children in care, which poses an immediate health, safety or personal rights risk to persons in care.

Resolution: Licensee immediately corrected the deficiencies by removing the shampoo and moved the medicine to a closed medicine cabinet.

Based on observation and record review, the licensee did not comply with the section cited above, child 2 (c2), c4 and c9 file has missing signed LIC 995A, which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee will provide LIC 995A to parents and licensee will submit copy of signed forms to the San Jose Regional Office by close of business 10/05/2022.

Based on observation and record review, the licensee did not comply with the section cited above, child 1 (c1) and c2 files have no LIC 9227 on file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee will have parent fill and sign LIC 9227 and submit copies of form the San Jose Regional Office by end of business 10/05/2022.

Based on observation and interview, the licensee did not comply with the section cited above, licensee converted the garage to living quarters and added a third bedroom without notifying the San Jose Regional Office for fire clearance, which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee will submit a new facilty sketch LIC 999 to the San Jose Regional office by close of business 10/05/2022.

Based on observation and record review, the licensee did not comply with the section cited above, Child 4 (c4) and c6 form is complete but signature parent signature is missing, which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee will have parents sign emergency information card and will submit copy of signed form to the San Jose Regional Office by close of business 10/05/2022.

Based on observation, the licensee did not comply with the section cited above, accessible medicine cabinet has no lock, storage shed gate has a malfunctioning latch where chemical are being stored, 12 inch hunting knife found in dining room hutch accessible to children, which poses an immediate health, safety or personal rights risk to persons in care.

Resolution: Licensee corrected the deficiencies during todays inspection.