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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274412756
Report Date: 10/10/2019
Date Signed: 10/15/2019 02:45:44 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:VALDEZ, LOURDESFACILITY NUMBER:
274412756
ADMINISTRATOR:VALDEZ, LOURDESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 728-6567
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 5DATE:
10/10/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Lourdes ValdezTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Lourdes Valdez for an unannounced annual/random inspection. LPA observed five day care children; 1 infant, 4 preschoolers, and her helper/sister ( Eva Valdez) present during today's visit. Lourdes states there are four adults living in the home; herself, her husband, and her sister. Licensee has a 13 year daughter. A review of staff records on 10/10/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Licensee's certifications for CPR and First Aid are current and expire on 01/2021. LPA reviewed assistants file. Licensee and assistant both completed the Mandated Reporter Training AB1207. LPA reviewed Licensee's and assistants immunization against pertussis and measles.

LPA inspected the indoor and outdoor areas of the home during today's visit. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean and orderly. Off limit areas inside the home are two bedrooms. Off limit areas outside the home: right side of yard which is fenced and locked storage shed.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Last practiced drill was 10/07/19. LPA observed a barricaded wall heater, a fully charged 3A40BC fire extinguisher, working smoke & carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee states that she does not have any weapons in the home. LPA observed that all detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Some items are kept in the locked laundry room area located outside of kitchen door.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 10/10/2019):
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
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: VALDEZ, LOURDES
FACILITY NUMBER: 274412756
VISIT DATE: 10/10/2019
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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.

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.
Licensee's email address LourdesValdez67@yahoo.com

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

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

No deficiency cited.

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

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
LIC809 (FAS) - (06/04)
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