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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270766755
Report Date: 09/20/2019
Date Signed: 09/20/2019 11:10:38 AM

COMPREHENSIVE INSPECTION
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:BANUELOS, BELENFACILITY NUMBER:
270766755
ADMINISTRATOR:BANUELOS, BELENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 675-3929
CITY:GONZALESSTATE: CAZIP CODE:
93926
CAPACITY:12CENSUS: 10DATE:
09/20/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Belen BanuelosTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced Annual required Inspection to the home today. The purpose of today’s visit is to ensure the facility is in compliance with Title 22 California Code of Regulations. LPA was greeted and granted entrance by the Licensee Belen Banuelos. Todays census is 10 preschool children. Licensee's hours of operation are Monday to Friday, 7:00AM to 5:30 PM. The Licensee and her husband are the only adults who resides in the home with their minor child 14 years old. Licensee's helper Taylor was present in the home today. Licensee's CPR and First Aid cards are current and will expire on 3/21/2021 for herself and for her helper. The Licensee is currently on probation, and understands the stipulations of her probation. There were no school aged children present.

LPA toured the indoor and outdoor areas of the home during today's visit. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's visit. Last fire drill was conducted on 10/12/2018. The Licensee has a working telephone in the home. LPA observed licensee uses a separated part of the home as day care area. Licensee stated children use part of the main home for nap time and for taking breakfast. LPA observed sufficient materials, toys, and play equipment for the children in care. The day care area is clean, orderly, and safe for the day care children. LPA did not observe a wall heater in the day care area (central heat). Off limit areas in the home are as follows: master bedroom, son's bedroom, and family patio. LPA reminded Licensee that the children must be supervised at all times whenever they are outside in the yard/ play area.

LPA observed a fully charged 3A10BC fire extinguisher serviced last on October 2018, working smoke/carbon monoxide detectors, and no bodies of water. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, poisons, medications, and other similar items are out of reach and inaccessible to children. Licensee states that she does not administer any medications at this time. Licensee and her helper have records for immunization against measles, pertussis and influenza according with the SB792. LPA reviewed 7 children's files and the form LIC9224 is in each child's file.

*******************Report dated 9/19/2019 continues in page 2***********************

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
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: BANUELOS, BELEN
FACILITY NUMBER: 270766755
VISIT DATE: 09/20/2019
NARRATIVE
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Report dated 9/20/2019 continues from page 1.

A review of staff records on 9/09/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period. Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours to ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 12 children in the home at any time, with a qualified assistant. The Licensee states that she does not transport children; and understands that children cannot be left in parked vehicles unattended any time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.htmLPA discussed the requirements of AB 633 whenever a Type A deficiency is cited. LPA also discussed "zero tolerance" related regulations with the Licensee. LPA observed licensee and her helper have not completed the required "mandated reporter" training mandatory for all licensees and their helpers and all adults in contact with children. LPA referred Licensee to the Department website: www.ccld.ca.gov and www.mandatedreporterca.com for additional information on the online training. LPA advised licensee of the pending Department regulation update re: Safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information. Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.Type B deficiencies are cited in LIC809-D, exit interview conducted, and a copy of this report was provided to the Licensee.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
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: BANUELOS, BELEN
FACILITY NUMBER: 270766755
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2019
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated

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reporter training every two years following the date on which he or she completed the initial mandated reporter training. This regulation was not met as evidenced by: Licensee and her helper do not have certificates of completion of the training. This poses a potential risk to the health and safety of the children in care.
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Type B
10/04/2019
Section Cited

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(A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
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This regulation was not met as evidenced by: Licensee last conducted/documented a fire drill on 10/12/2018 This poses a potential risk to the health and safety of the children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3