274415563-8-26-2020-07-CC-FCJO-BSULER-20200826084156

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274415563
Report Date: 08/25/2020
Date Signed: 08/26/2020 08:45:25 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:	MELGOZA DE ANAYA, ANA		FACILITY NUMBER:	274415563
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	08/25/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Ana Melgoza de Anaya		TIME COMPLETED:	12:00 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 announced Tele visit via Zoom for a change of capacity inspection. LPA met with licensee Ana Melgoza. Days and hours of operation are Monday to Saturday from 3:00 AM to 2:00 AM. The adults that reside in the home are the Licensee, her spouse Juan, her adult daughter Evelyn, and her tenant Isilda. There were not children in care present today. Licensee's minor children ages 12 and 11 reside in the home. Licensee's certifications for CPR and First Aid card is current and will expire on 2/04/22 LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has documented a fire drill during the last six months. Last fire drill was documented on 7/16/2020 The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the children in care. A fire inspection clearance was granted on 7/22/2020 by the Salinas Fire Department. Licensee has a tenant living in the garage. Licensee understands that garage is not approved for chid care use. Off limit areas inside are: Two bedrooms, one bathroom, and the garage. LPA observed there are no stairs in the home. LPA observed the home has fenced back yard. Licensee uses the back yard as playground for the children in care. Off limits out door areas are: The front yard, the left and right side yards, and a storage shed in the back yard. LPA observed there are not bodies of water. LPA observed a fully charged 3A40BC fire extinguisher and working smoke detectors. LPA observed the home has at least one working carbon monoxide detector. LPA observed there are not wall heaters or a fireplace 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. Licensee has in file proof of immunization for pertussis and measles and an opt out statement for influenza vaccine according with the SB792. *************Report dated 8/25/2020 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: 08/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2020

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: MELGOZA DE ANAYA, ANA	FACILITY NUMBER: 274415563
	VISIT DATE: 08/25/2020

NARRATIVE

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Report dated 8/25/2020 continues from page 1.

A review of staff records on 8/18/2020 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 in the future if a large license is approved she could not have more than 14 children in the home at any time. Licensee understands that a helper is required to assist in the home whenever the number of children is greater than 8, and ratio (age of the children) must be observed. The Licensee states that she is not currently offering transportation to children via vehicle and 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 observed that the Licensee has completed the required AB1207 "mandated reporter" training on 8/19/2020

No deficiencies were cited during today's inspection.
LPA conducted an exit interview with Licensee in Spanish and advised her that a large FCCH license will be approved pending on the following: 1) Approval from a manager of the Licensing Department.

A NOTICE OF SITE VISIT WAS ISSUED, PRINTED AND EMAILED TO LICENSEE AND LICENSEE MUST POST IT NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
This report has been emailed to applicant and applicant will reply to the email in lieu of her signature.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2020

LIC809 (FAS) - (06/04)

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