274415340-1-16-2020-07-CC-FCJO-BKVQYJ-20200116113514

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274415340
Report Date: 01/14/2020
Date Signed: 01/16/2020 11:35:23 AM

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:	AVILA, DORINA		FACILITY NUMBER:	274415340
ADMINISTRATOR:	AVILA, DORINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 229-8753
CITY:	SOLEDAD	STATE: CA	ZIP CODE:	93960
CAPACITY:	14	CENSUS: 0	DATE:	01/14/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Dorina Avila		TIME COMPLETED:	03:20 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 annual random inspection to the home today. LPA met with Dorina Avila, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Saturday from 6:00 AM to 6:000 PM. The adults that reside in the home are Licensee, her husband Sergio, and her son Sergio. LPA observed there were not children in care today. Licensee stated she has stopped providing care to children since September 2019. Licensee stated she works with migrant children. Licensee's CPR and First Aid Certification is current and will expire on 4/06/2021. LPA reviewed the Fire/Disaster drill log during today's inspection. Last fire drill was documented on 9/20/2019. 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 in the home are: all the second floor. LPA observed the home has a back yard and it is fenced. Licensee uses the back and the left side yard as playground. LPA observed a fully charged 3A40BC fire extinguisher last time serviced on January 2019, working smoke detectors and no bodies of water. LPA observed a working carbon monoxide detector in the home. 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 (IMS) with Licensees. LPA observed licensee has in file for herself the required proof of immunization for pertussis, influenza and measles according with the SB792. A review of staff records on 1/13/2020 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. ***********************************Report dated 1/14/2020 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: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

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: AVILA, DORINA	FACILITY NUMBER: 274415340
	VISIT DATE: 01/14/2020

NARRATIVE

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Report dated 1/14/2020 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 that in absence of a helper her license capacity is reduced to only 8 children and ratio (age of the children) must be observed. Licensee stated she does not transport children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.

Department website: www.ccld.ca.gov provided to Licensee.

LPA discussed the requirements of AB 633 with the Licensee. LPA also discussed "zero tolerance" related regulations with the Licensee. LPA advised Licensee of the required "Mandated Reporter" training, AB1207, which is mandatory for all Licensees and all the adults in contact with children. LPA provided Licensee with the website address for additional information: www.ccld.ca.gov
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 provided licensee with a Child Care Advocate email: rwillia1@dss.ca.gov

There were not deficiencies cited during today's inspection. Appeal rights was printed and given 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: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

LIC809 (FAS) - (06/04)

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