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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415563
Report Date: 02/09/2022
Date Signed: 02/09/2022 12:44:16 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:MELGOZA DE ANAYA, ANAFACILITY NUMBER:
274415563
ADMINISTRATOR:MELGOZA DE ANAYA, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 970-6744
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY:14CENSUS: 5DATE:
02/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ana Melgoza de AnayaTIME COMPLETED:
01:00 PM
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Licensing Program Analysts (LPAs) Fermin Campos-Jaramillo and Teodoro Trujillo conducted an unannounced annual required inspection to the home today. LPA met with licensee Ana Melgoza. Days and hours of operation are Monday to Saturday from 6:00 AM to 6:00 PM. The adults that reside in the home are the Licensee, her spouse Juan, and her tenant Isilda. There were five children in care present today, included 4 infants and one preschool age. Licensee's minor children ages 14 and 12 reside in the home. Licensee's certifications for CPR and First Aid card is current and will expire on 1/20/24. Present today was licensee daughter and helper Evelyn, her CPR expires on 5/3/23.
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 1/05/22. LPA obtained a copy of the Child Care Facility Roster during today's inspection and it is current. LPA reviewed eight children's files and observed they include 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 children in care. Off limit areas inside are: Two bedrooms, one bathroom, and the converted garage where Isilda resides. 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. LPA observed the home has a blocked fireplace in the home, inaccessible to the children in care. 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 2/09/22 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: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: 02/09/2022
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Report dated 2/09/22 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 with a large license she can 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 must be observed. The Licensee states 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 8/19/20 and her helper Evelyn on 8/21/20 Licensee understands the training is to be renewed every 2 years. Training website was provided: www.mandatedreporterca.com

A review of staff records on 2/08/22 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 Ana Melgoza 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 2/09/22 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: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: 02/09/2022
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Report dated 2/09/22 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 Ana Melgoza

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: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4