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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274413092
Report Date: 05/12/2022
Date Signed: 05/12/2022 04:05:07 PM


Document Has Been Signed on 05/12/2022 04:05 PM - It Cannot Be Edited

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, RUBICELDAFACILITY NUMBER:
274413092
ADMINISTRATOR:CHAVARIN, RUBICELDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 774-2273
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY:14CENSUS: 1DATE:
05/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Rubicelda ChavarinTIME COMPLETED:
04:15 PM
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Licensing Program Analysts (LPAs) Fermin Campos-Jaramillo and Teodoro Trujillo 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 17, 16, 14, and 9 years old. LPA observed there was one school age child in care during today's inspection. Certification for CPR and First Aid Card for Licensee is current and will expire on 8/28/2023 and for helper's Maria 8/28/2023 and Silvia 02/13/23. Licensee's brother Rafael was 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 seven children's file and observed file's are complete, including the parent's rights form, and the immunization records form. LPA observed that Licensee has conducted a fire drill, Last fire drill was documented on 11/27/2021. 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, LPA observed the area where the dogs are kept need to be cleaned more often. Licensee agreed to take care of this off limits area. 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.
*******************Report dated 05/12/2022 continues in page 2.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022
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: 05/12/2022
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***********************Report dated 05/12/2022 continues from page 1.

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 "mandated reporter" training that all Licensees and their helpers will be required to complete starting January 1, 2018. LPA observed the mandated reporter training completed on 04/15/2022, referred the Licensee to the Department website: www.ccld.ca.gov for additional information on the online training.
A review of staff records on 05/10/22 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 Rubicelda Chavarin was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/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-and-resources/safe-sleep as an additional resource. 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.

Report dated 05/12/22 continues on page 3.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
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: 05/12/2022
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Report dated 05/12/22 continuers from page 2.

Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Exit interview conducted and report was reviewed with the licensee Rubicelda Chavarin.

No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC809 (FAS) - (06/04)
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