274412895-1-18-2024-07-CC-FCJO-CZLQ8N-20240118105701

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274412895
Report Date: 01/18/2024
Date Signed: 01/18/2024 10:57:08 AM

Document Has Been Signed on 01/18/2024 10:57 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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: 4	DATE:	01/18/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Mirtha Rios Guzman		TIME COMPLETED:	11:05 AM

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 Analysts (LPA) Fermin Campos-Jaramillo conducted an unannounced annual 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 7:00 PM. The adults that reside in the home are the Licensee, her spouse Rigoberto, and her son Christopher. Also in the home reside Licensee's minor children ages 10, and 8 years old. LPA observed there were four children in care today including one infant and three preschool age. Certification for CPR and First Aid Card for Licensee and for her helper Ivorie are current and will expire on 3/19/24 and 5/25/25 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 reviewed 5 children files and observed files are complete, including the immunization records form and the parent's rights form. Licensee documented last fire drill on 1/10/24. 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 in the first floor, the attached garage. Off limits areas outside: A shed in the back yard and the side yards. Licensee keeps two dogs in the right side yard. The home has a back yard and it is fenced, Licensee uses it as playground. LPA observed a fully charged 3A40BC fire extinguisher last time serviced on January 2024, 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. Licensee stated she does not have weapons. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. According with the SB792, Licensee has proof of immunization for herself and for her helpers for pertussis, measles, and influenza. *******************Report dated 1/18/24 continues on page 2..

SUPERVISOR'S NAME: Susy Cervantes	TELEPHONE: (408) -32-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: RIOS GUZMAN, MIRTHA	FACILITY NUMBER: 274412895
	VISIT DATE: 01/18/2024

NARRATIVE

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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 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 observed that the Licensee and her helper Ivorie have renewed the "Mandated Reporter" training on 3/13/23 and 5/04/23 respectively and was advised that all adults in contact with children are required to complete the "mandated reporter" training. Licensee understands the training shall be renewed every two years. LPA referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training.
A review of staff records on 1/08/24 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 was reminded that all the adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource.

*****************************Report dated 1/18/24 continues in page 3

SUPERVISOR'S NAME: Susy Cervantes	TELEPHONE: (408) -32-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: RIOS GUZMAN, MIRTHA	FACILITY NUMBER: 274412895
	VISIT DATE: 01/18/2024

NARRATIVE

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********Report dated 1/18/24 continues from page 2.
LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Mirtha Rios Guzman confirmed that there are no Registered Sex Offenders living in the facility.

Exit interview conducted and report was reviewed with the licensee Mirtha Rios Guzman.

There are no deficiencies cited today.

A notice of site visit was handed to licensee and must remain posted for 30 days

SUPERVISOR'S NAME: Susy Cervantes	TELEPHONE: (408) -32-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC809 (FAS) - (06/04)

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