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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274416209
Report Date: 12/29/2021
Date Signed: 01/03/2022 11:21:59 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:MARTIN, SOCORROFACILITY NUMBER:
274416209
ADMINISTRATOR:SOCORRO MARTINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 682-8122
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY:14CENSUS: 5DATE:
12/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Socorro Martin TIME COMPLETED:
04:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Larios met with Socorro Martin, Licensee, for unannounced Required – 1 year annual inspection. LPA was granted access to the home by the Licensee. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 5:30 AM to 6:00 PM. Adults residing in the home are Licensee, spouse, children, and brother.

Licensee does have a current Child Care Facility Roster during today's inspection, which lists children that are enrolled. Licensee has liability insurance for the day care. Licensee has current CPR and First Aid certifications (expiration: 03/10/2022). Licensee has the required vaccines (MMR, Tdap, does not have the flu opt out) and does not have a current Mandated Reporter Training for Child Care Workers (expiration: 10/04/2018). LPA reviewed two staff files (Assistants) and the files were incomplete with the required forms.
LPA discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Licensee states that if a child will be isolated in the hallway of the home if necessary due to illness or communicable disease.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021
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: MARTIN, SOCORRO
FACILITY NUMBER: 274416209
VISIT DATE: 12/29/2021
NARRATIVE
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The home is clean and orderly, with central heating/air conditioning for safety & comfort. There are no open face heaters inside the home. Off limit areas in the home: the whole second floor, garage, and laundry room on the first floor. LPA observed a screened fireplace (located in the Family Room). Off limit areas outside the home: large storage shed, small shed, trash can area, build in BBQ, and chain link fence (dog area).

LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. Licensee stated that there are firearms stored on the premises. LPA inspected the locked storage area for the firearm and confirmed that ammunition were stored and locked separately from firearms. The home has two small sized pet dogs and one large sized pet dog. The dogs are kept at a designated area in the backyard that was fenced off. Licensee stated that the dogs are vaccinated and will be kept inaccessible to day care children.

All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. All poisons are locked in the attached off limits garage. Licensee states that she does not administer any medication to the day care children.

Licensee 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.

Supervision of children was discussed with 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. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time without two qualified adults present. Licensee states that she does transport day care children. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.


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, Socorro Martin. Deficiencies were issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021
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: MARTIN, SOCORRO
FACILITY NUMBER: 274416209
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/29/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records reviewed), the Licensee has expired Mandated Reporter Training & Assistants did not have proof of completion on file. That poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/05/2022
Plan of Correction
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Licensee states that herself and Assistants will complete the training and will submit proof of completion.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records reviewed, the Assistants did not have proof of immunizations on file. That poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/05/2022
Plan of Correction
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Licensee states she will submit proof of Assistants Immunization records.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 12/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/29/2021
LIC809 (FAS) - (06/04)
Page: 4 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: MARTIN, SOCORRO
FACILITY NUMBER: 274416209
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/29/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102370(d)(2)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 102370(j) or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records reviewed, one Assistant ( S-1) is not associated to the facility. That poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/05/2022
Plan of Correction
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Licensee states she will submit documents to CCL to get Assistant (S-1) associated to the facility.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records reviewed, Licensee and Assistants did not have proof of influenza or statement of opting out in file. That poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/05/2022
Plan of Correction
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Licensee states she will submit documents for influenza to CCL for her and Assistants.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 12/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/29/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4