274413092-2-20-2020-07-CC-FCJO-BLZ2B9-20200220161446

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274413092
Report Date: 02/20/2020
Date Signed: 02/20/2020 04:14:54 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:	CHAVARIN, RUBICELDA		FACILITY NUMBER:	274413092
ADMINISTRATOR:	CHAVARIN, RUBICELDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 774-2273
CITY:	SALINAS	STATE: CA	ZIP CODE:	93905
CAPACITY:	14	CENSUS: 1	DATE:	02/20/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Rubicelda Chavarin		TIME COMPLETED:	04:30 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 one year required inspection to the home today. LPA met with Rubicelda Chavarin, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 5:00 AM to 6:30 PM. The adults that reside in the home are the Licensee, her spouse Rolando, her brother Rafael, and her son Rafael. Also in the home reside Licensee's minor children ages 15, 13, 11, and 7 years old. LPA observed there was one preschool child in care during today's inspection. Certification for CPR and First Aid Card for Licensee is current and will expire on 8/10/2021 and for helper Maria 8/03/2021. Licensee's sons Rafael and a 11 years old minor son were at home when LPA arrived. 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 one child file and observed file is complete, including the parent's rights form, and the immunization records form. LPA observed that Licensee has not conducted a fire drill during the last six months. Last fire drill was documented on 5/07/2019. 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 which includes four bedrooms and two bathrooms. In the first floor the attached garage is off limits. Off limits areas outside: The right side yard and a storage in the back yard. The home has a back yard and it is fenced, Licensee uses it as playground. LPA observed licensee keeps two dogs in a off limits part of the back yard. Licensee stated the dogs are vaccinated. LPA observed a fully charged 3A40BC fire extinguisher last time serviced on July 2019, and at least one working smoke detector. LPA observed the home has a carbon monoxide detector. LPA observed barricaded stairs in the home. LPA observed the home has a barricaded fireplace in one of the child care on limits areas. 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 for pertussis, measles, and influenza. *******************Report dated 2/20/2020 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: 02/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020

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: CHAVARIN, RUBICELDA	FACILITY NUMBER: 274413092
	VISIT DATE: 02/20/2020

NARRATIVE

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****************************Report dated 2/20/2020 continues from page 1.
A review of staff records on 2/18/2020 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. The Licensee states that she transports 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 advised Licensee of the the required "mandated reporter" training that all Licensees and their helpers will be required to complete starting January 1, 2018. 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. LPA recommended licensee to enroll with the advocate program to receive updates.

Licensee 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.
One type B deficiency was cited during today's inspection. Licensee's rights form was printed and 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: 02/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: CHAVARIN, RUBICELDA	FACILITY NUMBER: 274413092
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/20/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/05/2020 Section Cited	1 2 3 4 5 6 7	(A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1.The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
	8 9 10 11 12 13 14	This regulation was not met as evidenced by: Licensee has not conducted or documented a fire drill since 5/7/2019. Licensee understands this poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020

LIC809 (FAS) - (06/04)

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