274408976-3-5-2020-07-CC-SCES-BMEP9W-20200305100751

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274408976
Report Date: 03/05/2020
Date Signed: 03/05/2020 10:07:57 AM

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:	JIMENEZ, ELVIA		FACILITY NUMBER:	274408976
ADMINISTRATOR:	ELVIA JIMENEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 444-9792
CITY:	SALINAS	STATE: CA	ZIP CODE:	93906
CAPACITY:	14	CENSUS: 3	DATE:	03/05/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Elvia Jimenez		TIME COMPLETED:	10:15 AM

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 3/5/2020 at 9:00 am, Licensing Program Analyst (LPA) Susy Cervantes met with licensee Elvia Jimenez for an annual inspection and explained the nature of today’s visit. Present were Licensee with three children: two infants and one preschool age. Adults living in the home are licensee and her husband Abel with one child age 16 years old. Days and hours of operation are Monday through Saturday, 5:00 am to 6:00 pm. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 3/2/20 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. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensee shall immediately remove the individual and prevent them from returning to the home or having contact with children in care. LPA toured the inside and outside of the home. LPA observed a blocked fireplace, no wall heaters, and no stairs. Off limits indoor: all three bedrooms, master bathroom, and attached garage. There are no bodies of water. Licensee stated there are no firearms/weapons in the home. LPA observed a 3A40BC fire extinguisher that was last serviced on 2/13/20. Smoke detector and Carbon Monoxide detectors are operable. LPA observed sufficient materials, toys, and play equipment for the children in care as well as safe healthful, and comfortable accommodations, furnishings, and equipment. Telephone is in working order. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children. Backyard is fenced. There are no pets. Off limits outdoor: right side yard and locked shed on the left side of the yard. *Continues on report dated 3/5/2020*

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

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: JIMENEZ, ELVIA	FACILITY NUMBER: 274408976
	VISIT DATE: 03/05/2020

NARRATIVE

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Continuation of report dated 3/5/2020
LPA reminded licensee that she can only have 14 children according to her license with an assistant. Children were supervised during the visit and LPA went over substitute options. Licensee stated that she does 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 received a copy of a current roster of the children. LPA observed a fire and disaster drill log that was last conducted on 2/5/20. LPA reviewed three children’s files. Children’s immunization records are documented, maintained, and updated in form PM286. LPA observed Notification of Parents’ Rights is in each child’s file. LPA observed that the Licensee has completed Mandated Reporter training on 3/31/19. Licensee has Pediatric CPR/1^st Aid expiring 11/30/21. Licensee has all needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza (decline statement) as well as TB testing.

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 immediate civil penalties for Zero Tolerance of $500. 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 provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. Safe sleep was discussed with the Licensee and Guide to Safe Sleep information was provided to the licensee. 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 in Spanish. Licensee was given appeal rights.
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: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

LIC809 (FAS) - (06/04)

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