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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415971
Report Date: 11/14/2020
Date Signed: 11/16/2020 03:27:57 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:ROCHA, YESENIAFACILITY NUMBER:
274415971
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
11/14/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Yesenia RochaTIME COMPLETED:
01:30 PM
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On 11/14/2020 at 12:00 PM, Licensing Program Analyst (LPA), Susy Cervantes, met with applicant, Yesenia Rocha and conducted a pre-licensing visit for location change and increase of capacity in this facility. Applicant's current license is #274415539 which is located at 1533 Barcelona Cir., Salinas, CA 93906. Applicant stated that she is the only adult currently living in this home. Applicant rents the house. Applicant has liability insurance and she understands that if she decides not to carry liability insurance in the future, she will have parent/authorized representative sign the Affidavit Regarding Liability Insurance for FCCH form (LIC 282). The days and hours of operation will be M-S from 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 11/12/2020 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 Applicant 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.

The entire home was inspected for health and safety hazards. The home has a working duo smoke and carbon monoxide detector, a working telephone and a fully charge 3A40BC fire extinguisher. Certifications for CPR and First Aid are up-to-date which expire 02/21/21. Fire clearance was granted on 11/09/2020. Preventative Health Practices training was complete on 04/06/19, licensee stated that she took the lead class and is waiting to receive her certificate, licensee understands that a license can not be granted until the certificate is received. Mandated Reporter training for Child Care Workers was completed on 02/07/19.

Continues on report dated 11/14/2020
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy CervantesTELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2020
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 2
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: ROCHA, YESENIA
FACILITY NUMBER: 274415971
VISIT DATE: 11/14/2020
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Continuation of report dated 11/14/2020

Applicant stated that there are no pets and no firearms/weapons in the home. Off limit areas inside: two bedrooms, master bedroom, and master bathroom. LPA observed no stairs, wall heaters, or bodies of water. The backyard and the front yard are fenced. Applicant stated that children will play in the front yard and the right side yard. Off limits outside: left side yard and back yard that are fenced off. There were age appropriate toys in the day care areas. No medication, cleaning products, hazardous and sharp objects were accessible to children and are stored in the top shelf in the master bedroom closet, under the magnet locked kitchen sink, and the top of the refrigerator.

Discipline policy was discussed with applicant and she understood that the children's personal rights should not be violated and corporal punishment is not allowed. Applicant stated that her discipline method will redirection and positive re-enforcement. Applicant stated that they will not transport children but understood the safety seat belt/car seat requirements.

A Family Child Care Home packet was reviewed with applicant. Licensing Department's website: www.ccld.ca.gov to obtain forms and regulations CCR, Title 22. LPA discussed SB 792 (Immunization's for Measles Pertussis and Influenza). Applicant was advised on the regulations that smoking, baby walkers, bouncers, excersaucers and other similar items are not allowed. The following was discussed, isolation of sick children; supervision of children; capacity options; requirements for reporting suspected child abuse; unusual incident/injuries; fire drills practiced at least twice a year and documented. LPA also discussed the requirements of AB 633 to applicant and provided applicant the fact sheet and a copy of Acknowledgement of receipt of Licensing Reports (LIC 9224). Zero Tolerance with $500 civil penalty was also explained to applicant.

LPA conducted an exit interview with the Applicant in Spanish. LPA informed Licensee that the report will be emailed. Licensee understands that in lieu of a signature, a read receipt or confirmation of receiving the report email must be submitted within 24 hours.
LPA advised applicant that Licensure for a large family child care home is granted pending the following:

- Certificate of Lead poisoning class is submitted
- Management's approval.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy CervantesTELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2020
LIC809 (FAS) - (06/04)
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