354404835-1-24-2020-07-CC-EBEN-BL5PJH-20200124102133

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 354404835
Report Date: 01/17/2020
Date Signed: 01/24/2020 10:21:37 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:	CEJA, BLANCA		FACILITY NUMBER:	354404835
ADMINISTRATOR:	CEJA, BLANCA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 637-1634
CITY:	HOLLISTER	STATE: CA	ZIP CODE:	95023
CAPACITY:	14	CENSUS:	DATE:	01/17/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Blanca Ceja		TIME COMPLETED:	03:30 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) Elizabeth Berumen conducted a 1 year required unannounced annual random inspection to the home today. LPA met with Blanca Ceja, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 5:00 AM to 5:00 PM. The adults that reside in the home are the Licensee, her son David and her spouse Jose L. Licensee states children left early; no day care children were present. LPA inspected the indoor and outdoor areas of the home during today's inspection. LPA reviewed the Child Care Facility Roster during today's inspection. LPA reviewed a fire disaster drill log; Last fire drill was documented on 1/13/2020. Licensee has current CPR & First Aid expiring on 08/31/2021. The Licensee has a working telephone in the home (landline line), cell phone (831) 245-5741. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: 3 bedrooms, the laundry room, and two bathrooms. Off limits areas outside: The right side yard. The home has a back yard and it is fenced. The licensee uses the back yard as playground for the children in care. LPA observed a fully charged 3A40BC fire extinguisher. LPA tested the smoke and carbon monoxide detectors both are functioning. No bodies of water were observed. The Licensee states there are no weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. LPA observed a day care room located in the converted garage. There is a screened fire place in the living room. Report dated 01/17/2020 continued on following page:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020

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: CEJA, BLANCA	FACILITY NUMBER: 354404835
	VISIT DATE: 01/17/2020

NARRATIVE

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Report dated 01/17/2020 continues from page 1.
LPA discussed Incidental Medical Services (IMS) with the Licensee. Licensee has proof of immunization for pertussis and measles. Licensee has a signed declaration declining influenza vaccine.
A review of staff records on 01/16/2020 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).

LPA provided Blanca Ceja the lead poisoning flyer to provide to parents.

No deficiencies were cited during today's inspection. 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: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020

LIC809 (FAS) - (06/04)

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