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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 274410167
Report Date: 06/13/2019
Date Signed: 06/14/2019 09:18:23 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2019 and conducted by Evaluator Fermin Campos-Jaramillo
COMPLAINT CONTROL NUMBER: 07-CC-20190610144846
FACILITY NAME:ROCHA, MARTHAFACILITY NUMBER:
274410167
ADMINISTRATOR:MARTHA ROCHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 422-1074
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY:14CENSUS: 3DATE:
06/13/2019
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Martha RochaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Licensee is made alterations to existing building without notifying Licensing office
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo met Martha Rocha, Licensee, and explained to her the reason of the inspection is in regards of the allegation stated above. LPA observed there were not day care children present today, LPA observed that only licensee's three minor children were present. LPA obtained pictures of the outdoor areas, and obtained copies of documents issued by the City of Salinas, Building Permit Division.
This Licensing Department has investigated the above allegation and based on LPA observations and the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, H&S 1596.80, are being cited on the attached LIC. 9099D.

Deficiency cited on next page LIC9099D

Notice of site inspection was printed and shall be posted in a visible place for 30 consecutive days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 07-CC-20190610144846
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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, MARTHA
FACILITY NUMBER: 274410167
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2019
Section Cited
CCR
102416.3(a)(4)
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Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: 4) Construction of exterior decks or porches. This requirement was not met as evidenced by:
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Licensee shall obtain a building permit for the alterations and will submit to this Department copies of the permit and a new sketch showing the changes in the outside on limits areas, or should submit proof that the alterations have been demolished by July 11, 2019.
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Licensee did not submit to this Licensing Department a copy of the sketch showing the alterations made to the outside on limits areas. Licensee understands that this poses a potential risk to the health and safety of the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 3