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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274410167
Report Date: 09/11/2019
Date Signed: 01/27/2020 02:51:09 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, MARTHAFACILITY NUMBER:
274410167
ADMINISTRATOR:MARTHA ROCHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 422-1074
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY:14CENSUS: 10DATE:
09/11/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Martha RochaTIME COMPLETED:
04:30 PM
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THIS IS AN AMENDED REPORT THAT SUPERSEDES REPORT DATED 09/11/2019.
Licensing Program Analysts (LPA), Fermin Campos-Jaramillo conducted an unannounced Plan of Correction (POC) inspection to the home today. LPA met with Martha Rocha, Licensee and explained to her this is a follow up inspection for the deficiencies cited on 8/28/2019. LPA observed Licensee was in the home with 10 day care children included one infant, four preschool age, and five school age. Licensee's minor children ages 9 and 7 years old were present and are included in the census. Licensee's helper Maria de Jesus was also present and helping to take care of the children. LPA verified that signed forms LIC9224 for last inspection on 8/28/2019 were in each child's file according with the AB633. LPA observed inspection report dated 8/28/2019 was posted

Type A deficiency 102416.5(d) cited on 8/28/2019 - for Licensee failing to observe the capacity of her license. Licensee submitted a Plan Of Corrections (POC) on 9/03/2019, POC was due on 8/29/2019. Licensee is being assessed civil penalties today in the amount of $500.00
LPA observed licensee is operating today in her license's capacity.

Not additional deficiencies are cited today.

NOTICE OF SITE VISIT WAS PRINTED AND HANDED TO LICENSEE AND SHALL REMAIN POSTED VISIBLE FOR THE FOLLOWING 30 DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
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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