274410338-7-1-2021-07-CC-FCJO-C4HRWY-20210701132354

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274410338
Report Date: 07/01/2021
Date Signed: 07/01/2021 01:24:00 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:	GOMEZ, HERLINDA		FACILITY NUMBER:	274410338
ADMINISTRATOR:	HERLINDA GOMEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 424-7900
CITY:	SALINAS	STATE: CA	ZIP CODE:	93905
CAPACITY:	14	CENSUS: 9	DATE:	07/01/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Herlinda Gomez		TIME COMPLETED:	01:30 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 Herlinda Gomez, Licensee, and explained the nature of today's inspection to them. Days and hours of operation are Monday to Sunday from 5:00 AM to 07:00 PM. The adults that reside in the home are Licensee, her spouse Jose, and her son Jorge. LPA observed licensee had 9 school age children in care. Licensee's husband Jose was present as a helper today. Licensee's certification for CPR and First Aid are current and will expire on 9/10/21 and for her spouse Jose on 9/10/21 as well. LPA toured the indoor and outdoor areas of the home during today's inspection. LPA reviewed the Child Care Facility Roster during today's inspection, obtained a copy, and it is current. LPA reviewed five children's files and observed that parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification and emergency information forms are in each file. LPA reviewed the Fire/Disaster drill log during today's visit and it is current. Last fire drill was documented on 3/24/2021. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside the home is the second floor, and the attached garages. LPA observed there are barricaded stairs in the home. The left and right side yards are off limits. LPA observed the home has a back yard and it is fenced. Licensee stated she uses the back yard as playground. LPA observed a fully charged 2A10BC fire extinguisher, working smoke detectors and no bodies of water. LPA observed a working carbon monoxide detector in the home. LPA observed there are no wall heaters in the home. 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 reminded Licensee about the Incidental Medical Services (IMS). Licensee has in file proof of having immunization for measles, flu, and pertussis as required by the SB792. Report dated 7/01/2021 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: 07/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

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: GOMEZ, HERLINDA	FACILITY NUMBER: 274410338
	VISIT DATE: 07/01/2021

NARRATIVE

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Report dated 7/01/21 continues from page 1.

A review of staff records on 6/30/21 indicates that all adults residing in the home or other 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. 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 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. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a helper must be present. Licensee understands that in absence of a helper her license capacity is reduced to only 8 children and ratio must be observed. LPA observed that licensee and her husband transport children via vehicle and they understand 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 Child care providers "mandated reporter" training (AB1207) that all Licensees and adults in contact with children will be required to complete starting January 1, 2018. LPA observed that Licensee completed the training on 11/11/2021 and her spouse on 3/24/20. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information on the online training.
LPA advised licensee of the new regulations on Safe sleep for infant children. and provided licensee with form LIC9227. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.
LPA provided licensee with the Lead Poisoning Facts sheet.

No deficiencies were cited during today's inspection. Appeal rights was printed and given to Licensee. Exit interview 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: 07/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

LIC809 (FAS) - (06/04)

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