274450182-9-1-2021-07-CC-FCJO-C6FTJC-20210901144607

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274450182
Report Date: 09/01/2021
Date Signed: 09/01/2021 02:46:12 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 DE MELGOZA, MARIA I.		FACILITY NUMBER:	274450182
ADMINISTRATOR:	MARIA MELGOZA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 632-2936
CITY:	CASTROVILLE	STATE: CA	ZIP CODE:	95012
CAPACITY:	14	CENSUS: 5	DATE:	09/01/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Maria Rocha de Melgoza		TIME COMPLETED:	02:55 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 Analysts (LPA) Fermin Campos-Jaramillo conducted an unannounced annual required inspection to the home today. LPA met with Maria Rocha de Melgoza, Licensee, and explained the nature of today's inspection to her. Licensee's 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 Everardo, and her mother in law Carolina. There were five children in care during today's inspection, included one infant, three school age, and one preschool age. Certification for CPR and First Aid Card for Licensee and her spouse (and helper) are current and will expire on 10/17/21 and on 6/06/22 for second helper Cindy. 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. Licensee documented a fire drill on 8/02/21. LPA reviewed five children's files and observed that parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification and emergency information forms are in each file. The Licensee has a working telephone in the home (land line). LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: Three bedrooms, one bathroom, and the attached garage. Off limits areas outside: The right side yard and a storage 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 2A10BC fire extinguisher that was last serviced on 4/15/21 and at least one working smoke detector. LPA observed the home has a carbon monoxide detector. LPA observed there are not stairs or wall heaters. Licensee has an small dog in the right side yard and licensee stated it is vaccinated. 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. LPA discussed Incidental Medical Services with licensee. According with the SB792, Licensee presented proof that she has immunization for herself and her husband for measles, pertussis and influenza and proof is in her personnel file. Report dated 09/01/21 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: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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: ROCHA DE MELGOZA, MARIA I.	FACILITY NUMBER: 274450182
	VISIT DATE: 09/01/2021

NARRATIVE

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Report dated 09/01/2019 continues from page 1.

A review of staff records on 08/31/21 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 to a small Family Child Care Home license, maximum 8. 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 observed that licensee and her helpers have renewed the mandated reporter training on 2/25/2020. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information on the online training.
LPA advised licensee of the new regulations on Safe sleep for infant children. and provided licensee with form LIC9227. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.
LPA provided licensee with the Lead Poisoning Facts sheet.

No deficiencies were cited during today's inspection. Licensee rights was printed and given 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: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

LIC809 (FAS) - (06/04)

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