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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274411449
Report Date: 08/29/2019
Date Signed: 09/03/2019 01:14:35 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:FERNANDEZ, VERONICAFACILITY NUMBER:
274411449
ADMINISTRATOR:FERNANDEZ, VERONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-4168
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 5DATE:
08/29/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Veronica FernandezTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Berumen conducted an unannounced annual random inspection. LPA met with Licensee, Veronica Fernandez and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM, The adults that reside in the home are the licensee, her spouse, Salvador Valencia and son, Salvador Fernandez. LPA observed 5 preschool children napping. Licensee has Certification for CPR and First Aid, expiring on 04/2/2021.

LPA inspected the indoor and outdoor areas of the home today. LPA reviewed current roster and obtained a copy. LPA reviewed five children files and observed that the files are complete. LPA reviewed fire disaster drill log; last practiced drill was 08/4/19.

The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. Off limit areas in the home: 3 bedrooms on the main floor and one bedroom (garage) downstairs. LPA notes that the bedroom downstairs was previously the garage. LPA observed barricaded stairs. Off limit areas outside the home: locked storage shed. LPA observed a fenced backyard and no bodies water.

LPA observed a fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #1 - REPORT DATED 08/29/2019)
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019
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, VERONICA
FACILITY NUMBER: 274411449
VISIT DATE: 08/29/2019
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LPA discussed Incidental Medical Services with licensee. According with the SB792, Licensee has proof of immunization against pertussis and measles. Veronica has a signed declaration declining the influenza (flu) vaccine.
A review of staff records on 08/27/19 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Supervision of children was discussed with Veronica Fernandez 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. Veronica Fernandez understands her capacity options and she understands that she cannot have more than 14 children in the home at any time with qualified staff and ratio must be followed. Veronica Fernandez does not transport children via vehicle but she understands that children cannot be left in parked vehicles unattended at any time. Licensee talks to children and uses redirection as form of discipline.

Department website: www.ccld.ca.gov provided to Licensee. LPA discussed the requirements of AB 633 whenever a Type A deficiency is cited. LPA also discussed "zero tolerance" related regulations with the Licensee. LPA advised licensee of the pending Department regulation update re: Safe sleep for infant children. LPA referred the Licensee to the Department website for additional information.

Effective January 1, 2019, AB 2370, Chapter 676, Statutes of 2018, requires all child care providers, upon enrolling or re-enrolling any child, to provide the parent or guardian with written information including the following: Risks and effects of lead exposure. Blood lead testing recommendations and requirements. Options for obtaining blood lead testing, including any programs that offer free or discounted tests.

No deficiency cited during today's inspection. Licensee's rights form was printed and provided to Licensee along with this report. Exit interview was conducted with licensee.



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

DATE: 08/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2