274405904-11-15-2019-07-CC-FCJO-BHXTVQ-20191115140420

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274405904
Report Date: 11/15/2019
Date Signed: 11/15/2019 02:04:29 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:	ROCHA, GRACIELA		FACILITY NUMBER:	274405904
ADMINISTRATOR:	ROCHA, GRACIELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 633-2106
CITY:	CASTROVILLE	STATE: CA	ZIP CODE:	95012
CAPACITY:	14	CENSUS: 3	DATE:	11/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Graciela Rocha		TIME COMPLETED:	02:15 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 Graciela Rocha, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM and Saturday 6:00 AM to 4:00 PM. The adults that reside in the home are the Licensee, her spouse Andres, her adult daughter Cindy, her adult son Marcos, and Licensee's brother in law Jose. LPA observed three children in care included one infant, one preschooler and one school age. Licensee stated the three children are her grandchildren. Present also in the home was Licensee's husband and helper Andres Rocha . Licensee's certifications for CPR and First Aid is current and will expire on 10/05/2021. LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the Child Care Facility Roster during today's inspection and it is current. LPA reviewed three children files and are complete and include the Parent's rights form and the immunization records form. LPA observed licensee has documented a fire drill on 11/11/2019. The Licensee has a working telephone (landline) in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. LPA observed the home has central A/C and heating. Off limit areas in the home are the four bedrooms, the master bathroom which is in the master bedroom, and the attached garage. The home washing and dryer area is located in the garage. LPA observed there are no stairs in the home. LPA observed a fully charged 3A40BC fire extinguisher, working smoke and 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, medications, and other similar items are stored inaccessible to children. LPA discussed Incidental Medical Services (IMS) with the Licensee. Licensee has in file proof of immunization for pertussis, measles, and influenza for herself and for her helper. A review of staff records on 11/13/2019 indicates that all the adults residing in the home or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. ***************************Report dated 11/15/2019 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: 11/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

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: ROCHA, GRACIELA	FACILITY NUMBER: 274405904
	VISIT DATE: 11/15/2019

NARRATIVE

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Report dated 11/15/2019 continues from page 1.

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 qualified assistant must be present. The Licensee states that she does not transports children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.

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.

LPA advised the Licensee of the required "mandated reporter" training that all Licensees will be required to complete starting January 1, 2018. Licensee and her husband agreed in taking the training whenever it is available in Spanish. LPA referred the Licensee to the Department website: 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. LPA provided licensee with a Child Care Advocate email: rwillia1@dss.ca.gov
No deficiencies were cited during today's inspection. Appeal rights was printed and given to Licensee. Exit interview and inspection 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: 11/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

LIC809 (FAS) - (06/04)

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