274450234-8-26-2021-07-CC-SCES-C69TAL-20210826143343

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274450234
Report Date: 08/26/2021
Date Signed: 08/26/2021 02:33:51 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, MARIA		FACILITY NUMBER:	274450234
ADMINISTRATOR:	MARIA FERNANDEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 223-7240
CITY:	SOLEDAD	STATE: CA	ZIP CODE:	93960
CAPACITY:	14	CENSUS: 3	DATE:	08/26/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Maria Fernandez		TIME COMPLETED:	02:40 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	On 08/26/2021 at 1:20 PM, Licensing Program Analyst (LPA) Susy Cervantes met with licensee, Maria Fernandez, for an annual inspection and explained the nature of today’s visit. Present during today’s visit were Licensee with 3 children: 2 infants and 1 preschool, licensee stated all three children are their grandchildren. Adults living in the home are licensee, their spouse and their son with two children ages 15 and 14. Days and hours of operation are Monday through Friday, 5:00 am to 6:00 pm. Licensee stated they are currently not providing care to outside families. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 08/26/2021 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 Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100 per person per day, minimum of $100 to a maximum of $500 per person for an initial violation, and a minimum of $100 to a maximum of $3000 per person for any subsequent violation within a 12-month period. LPA toured the inside and outside of the home. LPA observed a covered fireplace, no wall heater, and no stairs. Off limits indoor: garage, three bedrooms, master bedroom and master bath. There are no bodies of water. Licensee stated there are two dogs and their vaccinations are not current due to Covid-19. Licensee stated there are no weapons in the home. LPA observed a fully charged 3A40BC fire extinguisher. Smoke detector and Carbon Monoxide detectors are operable. Telephone is in working order. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children and stored in the top kitchen cabinets. Backyard is fenced. Off limits outdoor: shed, left and right side yards that are fenced. LPA reminded licensee that she can only have 14 children according to their license. *Continues on report dated 08/26/2021 pg. 1/2*

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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: FERNANDEZ, MARIA	FACILITY NUMBER: 274450234
	VISIT DATE: 08/26/2021

NARRATIVE

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Continuation of report dated 08/26/2021 pg. 2/2
Children were supervised during the visit and LPA went over substitute options. Licensee stated they do not transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.

LPA took a picture of a current roster of the children. LPA did not observe a current fire and disaster drill log, licensee stated they had not had children since January 2021. LPA reviewed 2 children’s files and observed a copy of the emergency information card (LIC 700) in each file. Infant individual sleeping plan (LIC 9227) for each infant under 12 months and a 15 minute check sleep log for infants under 24 months was discussed with Licensee and LPA provided LIC 9227 to them. LPA observed that the Licensee has not completed Mandated Reporter. Licensee has Pediatric CPR/1^st Aid expiring 02/01/2022. Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is on file for licensee.

Incidental Medical Services (IMS) policy was discussed with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing IMS at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

Licensee was reminded that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. LPA discussed the requirements of AB 633 with the Licensee, Maria Fernandez, and provided the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and the Licensee understands the requirements. LPA also discussed "zero tolerance" related regulations with the Licensee and was advised of the assessment for an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA discussed the “Lead Poisoning Facts Information Flyer” with licensee. Department website: http://ccld.ca.gov provided to Licensee.

Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made. An exit interview was conducted with Licensee in Spanish. Type B deficiency was cited during today’s inspection. Notice of site visit must remain posted for 30 days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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, MARIA	FACILITY NUMBER: 274450234
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/26/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/09/2021 Section Cited	1 2 3 4 5 6 7	1596.8662(b)(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training... 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 was not met as evidenced by:
	8 9 10 11 12 13 14	Based on observations: LPA observed that the Licensee has not completed Mandated Reporter training. This poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC809 (FAS) - (06/04)

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