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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274409931
Report Date: 09/27/2019
Date Signed: 09/30/2019 08:54:09 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:FERNANDEZ, MARIAFACILITY NUMBER:
274409931
ADMINISTRATOR:MARIA FERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-8059
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 7DATE:
09/27/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Maria FernandezTIME COMPLETED:
02:15 PM
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 Licensing Program Analyst (LPA) Elizabeth Berumen conducted an unannounced random inspection to the home. LPA met with Licensee, Maria Fernandez and explained the nature of today's visit. Also present during the visit was licensee's spouse/assistant, Juan Solano and 7 day care children (3 infants, 3 preschoolers, 1 School age). Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. The adults that reside in the home are the Licensee and her spouse. A review of staff records on September 25, 2019 indicates that all 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.

LPA inspected the indoor and outdoor areas of the home during today's visit. LPA reviewed completed Child Care Facility Roster and obtained copy. LPA reviewed the Fire/Disaster drill log, last drill conducted was on September 25, 2019. The Licensee has a working telephone (land line) in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean and safe for the day care children. Off limit areas in the home: 3 bedrooms, kitchen, hallway closet, screened fireplace, and attached garage. Off limit areas outside the home are two locked storage sheds and fenced off areas of the backyard where there is a third locked storage shed.

LPA observed a fully charged 3A40BC fire extinguisher, working smoke/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, and other similar items are stored in a locked storage cabinet inaccessible to children. Licensee understands that all poisons are to be locked and stored inaccessible to children.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
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 2
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: FERNANDEZ, MARIA
FACILITY NUMBER: 274409931
VISIT DATE: 09/27/2019
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LPA reviewed Licensee's and Assistant files today. Licensee has current CPR & First Aid, expiring on March 15. 2021. Juan Solano (assistant) and Licensee completed the Mandated Reporter Training on April 2, 2018. Licensee understands that the course it to be completed every two years. LPA reviewed immunization records for Licensee and her spouse against measles, pertussis and influenza.

LPA discussed Lead Safety Information (AB 2370). Chapter 676, statues of 2018, requires all child care providers, upon enrolling or re-enrolling any child, to provide the parent or guardian with written information. LPA provided Licensee with, Effects of Lead exposure flyer to handout to parents.

Safe Sleep was discussed: place infants on their backs when sleeping, use a firm sleep surface such as a mattress in a safety approved crib, keep soft bedding such as blankets, pillows, toys out baby's sleep area and ensure that pacifiers have nothing attached to them. LPA emailed Licensee link to access information.

LPA discussed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, etc.


Exit Interview was conducted. A copy of this report was provided to the Licensee at the conclusion of the inspection.

No deficiency cited during today's inspection.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
LIC809 (FAS) - (06/04)
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