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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354410303
Report Date: 04/05/2023
Date Signed: 04/05/2023 05:31:03 PM


Document Has Been Signed on 04/05/2023 05:31 PM - It Cannot Be Edited

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:VAZQUEZ, MARIAFACILITY NUMBER:
354410303
ADMINISTRATOR:MARIA VAZQUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 726-7179
CITY:AROMASSTATE: CAZIP CODE:
95004
CAPACITY:14CENSUS: 4DATE:
04/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ana VazquezTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual inspection to the home today. LPA met with Ana Vazquez, licensee's daughter and helper and explained the nature of today's inspection to her. Ana stated licensee Maria will not be in today. Days and hours of operation are Monday to Friday 6:00 AM to 6:00 PM., and Saturdays 6:00 AM to 3:00 PM. Ana stated the adults that reside in the home are: Licensee Maria, her husband Juan, and the adults children an in laws Angelica, Arantza, Danilo and Ana. LPA observed there were four preschool children present in the home during the inspection, Certification for CPR and First Aid Card for Licensee and for Ana are current and will expire on 3/8/25 and 2/4/25 respectively.

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 five children files and observed files are complete. LPA observed that Licensee has conducted a fire drill during the last six months. Last fire drill was documented on 2/24/23
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: Five bedrooms, two bathrooms, and the laundry area. Off limits areas outside: The detached garages and all the front yard. The home is located in a rural area. Licensee has a fenced patio accessible from the living room of the house. Licensee uses patio as playground for the children in care.
LPA observed a fully charged 3A40BC fire extinguisher and at least one working smoke detector. LPA observed the home has a carbon monoxide detector. LPA observed there are not stairs inside the home. LPA observed the home does not have wall heaters, or bodies of water. LPA observed a barricaded fireplace located in the living room. Licensee stated she does not have any pets. The Licensee states that she does not have weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.

*******************Report dated 04/05/23 continues in page 2.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2023
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: VAZQUEZ, MARIA
FACILITY NUMBER: 354410303
VISIT DATE: 04/05/2023
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Report dated 4/05/23 continues from page 1

According with the SB792, Licensee has proof of immunization for herself for pertussis, measles, and influenza.
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 current capacity options and she understands that she cannot have more than 14 children in the home at any time, ratio (age of the children) must be observed, and a helper must be present whenever there are more than 8 children in care. Licensee understands in absence of a helper her license capacity is reduced to 8 only and ratio must be observed. The Licensee states that she does 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 licensee and her helper Ana have completed the mandated reporter training on 8/22/22 and 2/23/23 respectively. Licensee understands the training is mandatory for all the adults in her home in contact with the children in care and training shall be renewed every two years. LPA provided the training website www.mandatedreporterca.com to the licensee for additional information on the online training.

A review of staff records on 4/04/23 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Ana Vazquez was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

************** Report dated 4/05/23 continues on page 3.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
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: VAZQUEZ, MARIA
FACILITY NUMBER: 354410303
VISIT DATE: 04/05/2023
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Report dated 4/05/23 continues from page 2.

LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800)514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with the licensee's helper Ana Vazquez.

No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
LIC809 (FAS) - (06/04)
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