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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415251
Report Date: 06/15/2023
Date Signed: 06/15/2023 01:13:28 PM


Document Has Been Signed on 06/15/2023 01:13 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:SALDIVAR, BEATRIZFACILITY NUMBER:
274415251
ADMINISTRATOR:SALDIVAR, BEATRIZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 578-7290
CITY:CASTROVILLESTATE: CAZIP CODE:
95012
CAPACITY:14CENSUS: 11DATE:
06/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Beatriz SaldivarTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced inspection to the home today. LPA met with Beatriz Saldivar, Licensee and explained, the nature of today's inspection to her. Days and hours of operation are Monday to Saturday from 05:30 AM to 6:00 PM. The adults that reside in the home are the Licensee, and her spouse Sergio. Also in the home reside licensee's minor children ages 16, 11, and five years old. There were eleven children in care during today's inspection, including two infants, four school age, and five preschoolers. Certification for CPR and First Aid Card for Licensee and her spouse Sergio are current and will expire on 8/19/23 and 02/01/24 respectively.
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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 observed that Licensee has documented a fire drill on 6/07/23. LPA reviewed five children files and are complete including the parent's rights form and the immunization records form.

The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. LPA observd the day care area is located at the back of the home and the entrance is by the left side yard. Off limit areas inside are: Four bedrooms, one bathroom, one kitchen and living room, and the attached garage. Off limits areas outside: A small storage shed in the back yard where Licensee keeps some tools. LPA has observed home has a left yard, it is fenced and used as a play yard. LPA observed no bodies of water, stairs or wall heaters.

LPA observed a fully charged 3A40BC fire extinguisher last time serviced on 11/08/22 and at least one working smoke detector. LPA observed the home has a carbon monoxide detector. Licensee stated they have two small dogs in the home, they are kept on the right side yard. Licensee states that there are no weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.

Report dated 6/15/23 continues in page 2.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
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: SALDIVAR, BEATRIZ
FACILITY NUMBER: 274415251
VISIT DATE: 06/15/2023
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Report dated 6/15/23 continues from page 1.

According with the SB792, Licensee has presented proof that she has immunization for herself and for helper/husband Sergio for measles, pertussis and influenza.

Supervision of children was discussed with Licensee and she understands that she or qualified helpers must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands the 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 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 transport children via vehicle and that she understands that children cannot be left in parked vehicles unattended at any time.
Department website: www.ccld.ca.gov provided to Licensee.

LPA observed that Licensee and her spouse have renewed the "Mandated Reporter" training on 02/03/22 her spouse on 02/14/22. Licensee understands the training must be renewed every two years. LPA referred the Licensee to the Department website: www.mandatedreporterca.com for additional information on the online training.
A review of staff records on 6/06/23 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 Beatriz Saldivar 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.

Report dated 6/15/23 continues on page 3.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
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: SALDIVAR, BEATRIZ
FACILITY NUMBER: 274415251
VISIT DATE: 06/15/2023
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Report dated 6/15/23 continuers 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 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 Beatriz Saldivar.

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: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
LIC809 (FAS) - (06/04)
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