274412895-8-12-2019-07-CC-FCJO-BEYUQT-20190812154739

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274412895
Report Date: 08/12/2019
Date Signed: 08/12/2019 03:47:45 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:	RIOS GUZMAN, MIRTHA		FACILITY NUMBER:	274412895
ADMINISTRATOR:	RIOS GUZMAN, MIRTHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 775-9839
CITY:	GREENFIELD	STATE: CA	ZIP CODE:	93927
CAPACITY:	14	CENSUS: 8	DATE:	08/12/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Mirtha Rios-Guzman		TIME COMPLETED:	04:00 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 Mirtha Rios-Guzman, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Saturday from 4:00 AM to 2:00 AM. The adults that reside in the home are the Licensee, and her spouse Rigoberto. Licensee's minor children ages 17, 6, and 4 also reside in the home. LPA observed there were 8 children in care during today's inspection, included three infants, and five preschool age. Licensee's helper Yazmin was also present today during the inspection. Certification for CPR and First Aid Card for Licensee and her helper are current and will expire on 3/22/2020 and 3/15/2021 respectively. LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the children's roster today and it is current. LPA randomly reviewed five children files and observed files are complete. LPA observed that Licensee has conducted a fire drill during the last six months. Last fire drill was documented on 6/18/2019. 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 are: All the second floor, and the garage, the living room, and one bedroom in the first floor. Off limits areas outside: The right and left side yards. The home has back yard and it is fenced, Licensee uses it as playground. LPA observed a fully charged 3A40BC fire extinguisher and at least one working smoke detector. LPA observed the home has a carbon monoxide detector. LPA observed there are barricaded stairs in the home. LPA observed the home does not have wall heaters, or bodies of water. LPA observed the home has a barricaded fireplace in the on limits area. Licensee has two pets, and stated are vaccinated. 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 discussed Incidental Medical Services with licensee. According with the SB792, Licensee has proof of immunization for herself and for her helper Yazmin for pertussis, measles, and influenza. *******************Report dated 08/12/2019 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: 08/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019

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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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: RIOS GUZMAN, MIRTHA	FACILITY NUMBER: 274412895
	VISIT DATE: 08/12/2019

NARRATIVE

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Report dated 08/12/2019 continues from page 1.
A review of staff records on 08/09/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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 the 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. The 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 in absence of a helper the capacity of her license is reduced in capacity and ratio (age of the children)to a small Family Child Care Home license maximum 8. Licensee understands her own children under the age of 10 years old, count in the capacity of her license. The Licensee states that she does not transport children via vehicle and that she understands that children cannot be left in parked vehicles unattended at any time. Licensee uses redirection and communication with children as a 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 observed that the Licensee and her helper have completed the "Mandated Reporter" training on 01/14/2019 and was advised that all adults in contact with children are required to complete the "mandated reporter" training. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information on the online training.
LPA advised licensee of the pending Department regulation update re: Safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.
dLicensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.
There were not deficiencies cited during today's inspection. Licensee's rights form was printed both in English and Spanish and was handed 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: 08/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019

LIC809 (FAS) - (06/04)

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