274403393-6-26-2019-07-CC-FCJO-BDHU6Q-20190626151843

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274403393
Report Date: 06/26/2019
Date Signed: 06/26/2019 03:18:52 PM

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:	MENDOZA, MARIA		FACILITY NUMBER:	274403393
ADMINISTRATOR:	MENDOZA, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 751-3231
CITY:	SALINAS	STATE: CA	ZIP CODE:	93905
CAPACITY:	14	CENSUS: 5	DATE:	06/26/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Maria Mendoza		TIME COMPLETED:	03:30 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) Fermin Campos-Jaramillo conducted an unannounced annual random inspection to the home today. LPA met with Maria Mendoza, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 5:00 AM to 11:00 PM, and Saturdays from 5:00 AM to 1:00 PM. The adults that reside in the home are the Licensee, her spouse Hugo, her daughters Evelyn and Michelle, her mother Maria, and her sons Hugo and Bryan. Licensee's helper Maria was also present. LPA observed five children in care during today's inspection, included three school age and two pre-school age. Licensee Certifications for CPR and First Aid card are current an will expire on 07/17/2019 for licensee and for Maria on 7/27/2020. LPA toured the indoor and outdoor areas of the home during today's inspection. LPA requested a copy of the Child Care Facility Roster during today's inspection and it was not available. Licensee has documented a fire drill during the last six months. Last fire drill was documented on 2/16/2019. LPA reviewed six children's files and observed that parent's rights forms, consents for emergency medical treatment forms, and Identification and emergency information forms are in each file. LPA observed that the immunization records form was not in the children's files. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: Five bedrooms, three bathrooms, the laundry area and the attached garage. LPA observed there are not stairs in the home. The home has a fireplace and it is barricaded. Off limits areas outside: Two storage sheds in the back yard, and the far back yard. LPA observed the back yard is fenced. Licensee uses a portion of the back yard as playground whenever the weather allows it. LPA observed a fully charged 3A40BC fire extinguisher and working smoke detectors. LPA observed the home has at least one working carbon monoxide detector and no bodies of water. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. LPA discussed Incidental Medical Services (IMS) with the Licensee. **************Report dated 06/26/2019 continues in page 2.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

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: MENDOZA, MARIA	FACILITY NUMBER: 274403393
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/26/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/10/2019 Section Cited CCR 102417(g)(8)	1 2 3 4 5 6 7	Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This regulation was not met as evidenced by: Licensee did not have a current and complete children's roster. Licensee understands this poses a potential risk to the children in care.	1 2 3 4 5 6 7	Licensee shall complete a children roster including all the children in care and will submit a copy to Licensing Department by July 10, 2019.
Type B 07/10/2019 Section Cited CCR 102418(g)(1)	1 2 3 4 5 6 7	The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required	1 2 3 4 5 6 7	Licensee shall complete a immunization form PM280 for each child in care and will submit a copy to Licensing Department by 07/10/2019.
	8 9 10 11 12 13 14	immunizations after enrollment in the family day care home. This regulation was not met as evidenced by: LPA observed that none of the children's files include a immunization form PM286. Licensee understands this poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

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: MENDOZA, MARIA	FACILITY NUMBER: 274403393
	VISIT DATE: 06/26/2019

NARRATIVE

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***********Report dated 06/26/2019 continues from page 1.

Licensee has in file proof of having immunization for measles, pertussis and influenza for herself and for her helpers. A review of staff records on 06/26/2019 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 and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time, and a helper must be present whenever there are more than 8 children in care. Licensee understands that her license's capacity is reduced to only 8 if a helper is not present in the home, and ratio (age of the children) must be observed. The Licensee states that she transports children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time. Licensee uses redirection and communication with children as a form of discipline.
Department website: www.ccld.ca.gov provided to Licensee.
LPA discussed the requirements of AB 633 with the Licensee. LPA also discussed "zero tolerance" related regulations with the Licensee.
Licensee was advised to obtain certificate of completion of the mandated reporter training either online or with the local R.R. office (MAOF). Licensee understands that all the adults in contact with children are required to take the training. LPA referred the 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.

Deficiencies type B were cited during today's inspection. Licensee rights forms in Spanish and in English were printed and provided to Licensee. Exit interview was conducted with Licensee in Spanish.
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 Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

LIC809 (FAS) - (06/04)

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