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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274450252
Report Date: 09/13/2019
Date Signed: 09/13/2019 10:18:22 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:ROCHA, BLANCA ESTELAFACILITY NUMBER:
274450252
ADMINISTRATOR:ROCHA, BLANCA ESTELLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 761-2540
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 6DATE:
09/13/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Blanca RochaTIME COMPLETED:
10:33 AM
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Unannounced random visit made by Mahvash Behbood. Met licensee, Estela Rocha, purpose of the visit explained. Present were 6 children including her grandson (under 2 ), her helper and her adult daughter. Days and hours of operation is M through F from 6 AM to 6 PM. Inside and outside of the home inspected. children and staff file reviewed.
There are no bodies of water on the property.
Licensee stated there are no gun at home. Cleaning supplies stored inaccessible to children. Fire place properly barricaded.
Fire extinguisher is full and correct size. Smoke and carbon monoxide are operational. Licensee states the heater work properly. There are no stairs in the home.
Toys and play equipment are safe and age appropriate.
Though she has cell phone her land line telephone is listed with licensing. She confirmed it is working. Children were supervised during the visit.
Discussed with licensee children are not to be left in parked vehicles.
Backyard where children play is fenced.
Children's roster is up to date. There is an emergency information on file for all children in care. The fire/disaster drill log is documented, The last fire drill date documented is 09/2019.
Living in the home are licensee, her adult daughter, her 10 year old daughter and her infant grandson. All adults living home have criminal record clearances. Licensee and her helper have proof of immunization on file. They both completed the Mandated Child Abuse Training.
Licensee's CPR and First Aid expires in 01/2021, her helper's expires in 04/2020.
Licensee is not providing IMS.
Off limits: All bedrooms, one bathroom, laundry room and Garage. The back yard is divided by a fence, the part behind the fence is off limit.
No deficiency noted during today's visit
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019
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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