274405866-8-13-2021-07-CC-SCES-C5UR7R-20210813124642

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274405866
Report Date: 08/13/2021
Date Signed: 08/13/2021 12:46:50 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:	BARRIENTOS, CECILIA		FACILITY NUMBER:	274405866
ADMINISTRATOR:	BARRIENTOS, CECILIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 771-0626
CITY:	SALINAS	STATE: CA	ZIP CODE:	93901
CAPACITY:	14	CENSUS: 8	DATE:	08/13/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Cecilia Barrientos		TIME COMPLETED:	01:00 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	On 08/13/21 at 11:45 AM, Licensing Program Analyst (LPA) Susy Cervantes met with licensee, Cecilia Barrientos, for an annual inspection and explained the nature of today’s visit. Present during today’s visit were Licensee, their spouse/assistant with 8 children: 1 infant, 2 school age and 5 preschool. Adults living in the home are licensee, their spouse, two adult daughters with one child age 17. Days and hours of operation are Monday through Saturday, 5:00 am to 6:30 pm. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 08/10/2021 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100 per person per day, minimum of $100 to a maximum of $500 per person for an initial violation, and a minimum of $100 to a maximum of $3000 per person for any subsequent violation within a 12-month period. LPA toured the inside and outside of the home. LPA observed a blocked fireplace, no wall heater, and no stairs. Off limits indoor: kitchen that is gated, two bedrooms, master bedroom, and master bath. There are no bodies of water. Licensee stated there are no pets or weapons. LPA observed a 3A40BC and 2A10BC fire extinguishers that were last serviced on 06/09/21. Smoke detector and Carbon Monoxide detectors are operable. Telephone is in working order. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children and stored in the off limits kitchen. Backyard is fenced. Off limits outdoor: garage and additional back yard that is gated and locked. LPA reminded licensee that she can only have 14 children according to their license. *Continues on report dated 08/13/2021 pg. 1/2*

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

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: BARRIENTOS, CECILIA	FACILITY NUMBER: 274405866
	VISIT DATE: 08/13/2021

NARRATIVE

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Continuation of report dated 08/13/2021 pg. 2/2

Children were supervised during the visit and LPA went over substitute options. Licensee stated they do not transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.

LPA took a picture of a current roster of the children. LPA observed a fire and disaster drill log that was last conducted on 07/01/21. LPA reviewed 5 children’s files and observed a copy of the emergency information card (LIC 700) in each file. Infant individual sleeping plan (LIC 9227) for each infant under 12 months and a 15 minute check sleep log for infants under 24 months was in file and reviewed by Licensee. LPA observed that the Licensee and assistant have completed Mandated Reporter training on 11/22/20. Licensee and assistant have Pediatric CPR/1^st Aid expiring 10/22/21. Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is on file for licensee and assistant.

Incidental Medical Services (IMS) policy was discussed with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing IMS at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

Licensee was reminded that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. LPA discussed the requirements of AB 633 with the Licensee (provide name) and provided the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and the Licensee understands the requirements. Upon receipt, Licensee (provide name) shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LPA also discussed "zero tolerance" related regulations with the Licensee/Director, (provide name) and was advised of the assessment for an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA discussed the “Lead Poisoning Facts Information Flyer” to the facility. Department website: http://ccld.ca.gov provided to Licensee.

Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

An exit interview was conducted with Licensee. No deficiencies were cited during today’s inspection. Notice of site visit must remain posted for 30 days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC809 (FAS) - (06/04)

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