274414483-12-17-2019-07-CC-SCES-BJXU9S-20191217142337

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274414483
Report Date: 12/17/2019
Date Signed: 12/17/2019 02:23:48 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:	ARIZMENDI, CONNIE M		FACILITY NUMBER:	274414483
ADMINISTRATOR:	ARIZMENDI, CONNIE M		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 676-5071
CITY:	SALINAS	STATE: CA	ZIP CODE:	93906
CAPACITY:	14	CENSUS: 6	DATE:	12/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Connie Arizmendi		TIME COMPLETED:	02:30 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	LPA Susy Cervantes met with licensee Connie Arizmendi for an annual/random inspection and explained the nature of today’s visit. Present were Licensee and her 10 year old son with 6 children: 2 infants, one school age, and 3 preschool. Adults living in the home are Licensee, her husband Moises with two children ages 10 and 13. Days and hours of operation are Monday through Friday, 6:00 am to 6:00 pm. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 12/16/19 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100 per person per day, minimum of $100 to a maximum of $500 per person for an initial violation, and a minimum of $100 to a maximum of $3000 per person for any subsequent violation within a 12-month period. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensee shall immediately remove the individual and prevent them from returning to the home or having contact with children in care. LPA toured the inside and outside of the home. LPA observed a covered fireplace and no wall heaters. LPA observed no stairs. Off limits indoor: attached garage, 3 bedrooms, and master bathroom. There are no bodies of water. Licensee stated there are no firearms/weapons in the home. LPA observed a fully charged 3A40BC fire extinguisher. Smoke detector and Carbon Monoxide detectors are operable. LPA observed sufficient materials, toys, and play equipment for the children in care as well as safe healthful, and comfortable accommodations, furnishings, and equipment. Telephone is in working order. Medicines, poisons and cleaning supplies are inaccessible to the children and kept in the top hallway cabinet. Backyard is fenced. There is a dog, Licensee stated the dog is vaccinated. Off limits outdoor: right side yard and left side yard with a locked shed. *Continues on report dated 12/17/2019*

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

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: ARIZMENDI, CONNIE M	FACILITY NUMBER: 274414483
	VISIT DATE: 12/17/2019

NARRATIVE

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LPA reminded licensee that she can only have 14 children according to her license with an assistant. Children were supervised during the visit and LPA went over substitute options. Licensee stated that she does not transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.

LPA took a picture of a current roster of the children. LPA observed a fire and disaster drill log that was last conducted on 8/15/19. LPA reviewed 6 children’s files. Children’s immunization records are not documented, maintained, and updated in form PM286. LPA observed Notification of Parents’ Rights is in each child’s file. LPA observed that the Licensee has completed Mandated Reporter training, LPA advised licensee to take the online course at www.mandatedreporterca.com. Licensee has Pediatric CPR/1^st Aid expiring 1/26/20. Licensee showed proof of all needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing.

Incidental Medical Services (IMS) policy was discussed with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing IMS (Incidental Medical Services) at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

Licensee was reminded that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. LPA discussed the immediate civil penalties for Zero Tolerance of $500. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. Safe sleep was discussed with the Licensee and Guide to Safe Sleep information was provided to the licensee. Department website: http://ccld.ca.gov provided to Licensee.

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.

An exit interview was conducted with Licensee in Spanish. LPA reviewed deficiencies, plans of correction, and licensee was given appeal rights. Type B deficiencies were cited during today's inspection. Notice of site visit must remain posted for 30 days

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

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: ARIZMENDI, CONNIE M	FACILITY NUMBER: 274414483
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/17/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/31/2019 Section Cited	1 2 3 4 5 6 7	Immunizations The family day care home shall record each pupil's immunization on the California School Immunization Record, PM 286 (6/95).
	8 9 10 11 12 13 14	This requirement was not met as evidence by: Children’s immunization records are not documented, maintained, and updated in form PM286. This poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
Type B 01/31/2020 Section Cited	1 2 3 4 5 6 7	On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider. . . two years following the date on which he or she completed the initial mandated reporter training.
	8 9 10 11 12 13 14	This requirement was not met as evidence by: LPA observed that the Licensee has completed Mandated Reporter training. This poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14

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: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

LIC809 (FAS) - (06/04)

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