274450075-12-10-2019-07-CC-FCJO-BJQRLX-20191210120752

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274450075
Report Date: 12/10/2019
Date Signed: 12/10/2019 12:07:58 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:	FERNANDEZ, ANA		FACILITY NUMBER:	274450075
ADMINISTRATOR:	ANA FERNANDEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 758-2350
CITY:	SALINAS	STATE: CA	ZIP CODE:	93905
CAPACITY:	14	CENSUS: 2	DATE:	12/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Ana Fernandez		TIME COMPLETED:	12:25 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 Ana Fernandez, 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 6:00 PM. The adults that reside in the home are the Licensee and her friend and helper Lorena Ortiz. Also in the home reside Licensee's and Lorena's minor children ages 16, 12 and 8 years old. LPA observed there were two children in care today. Certification for CPR and First Aid Card for Licensee and for her helper Lorena are current and will expire on 10/26/2021 for both of them. LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the children's roster today and it is current. LPA reviewed four children files and observed files are complete, including the immunization records form and the parent's rights form. Licensee documented last fire drill on 11/19/2019. 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 inside are: All the second floor, and in the first floor, the living room and the attached garage. Off limits areas outside: A shed in the back yard. The home has a back yard and it is fenced, Licensee uses it as playground. LPA observed a fully charged 3A40BC fire extinguisher last time serviced on March 2019, and at least one working smoke detector. LPA observed the home has a carbon monoxide detector. LPA observed there are barricaded stairs in the home. LPA observed the home does not have wall heaters, or bodies of water. LPA observed the home has a barricaded fireplace. Licensee stated she does not have weapons. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. LPA discussed Incidental Medical Services with licensee. According with the SB792, Licensee has proof of immunization for herself and for her helpers for pertussis, measles, and influenza. *******************Report dated 12/10/2019 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: 12/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019

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: FERNANDEZ, ANA	FACILITY NUMBER: 274450075
	VISIT DATE: 12/10/2019

NARRATIVE

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****************Report dated 12/10/2019 continues from page 1.

A review of staff records on 12/06/2019 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 she cannot have more than 14 children in the home at any time and a helper must be present. Licensee understands in absence of a helper the capacity of her license is reduced in capacity and ratio (age of the children) to a small Family Child Care Home license, maximum 8. Licensee understands (her) children living in her home under the age of ten years old count as part of the capacity of her license. The Licensee states that she does not transport children via vehicle and that 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 and her helper Lorena have completed the "Mandated Reporter" training on 10/27/19 and was advised that all adults in contact with children are required to complete the "mandated reporter" training. LPA referred the Licensee to the training website: www.mandatedreporterca,com for additional information on the online training.
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. There were not deficiencies cited during today's inspection. Licensee's rights form was printed both in English and Spanish and was handed 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: 12/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019

LIC809 (FAS) - (06/04)

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