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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354411125
Report Date: 01/10/2020
Date Signed: 01/29/2020 03:27:53 PM

COMPREHENSIVE INSPECTION
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, MARIA ISABELFACILITY NUMBER:
354411125
ADMINISTRATOR:CEJA, MARIA ISABELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 245-5997
CITY:SAN JUAN BAUTISTASTATE: CAZIP CODE:
95045
CAPACITY:14CENSUS: 6DATE:
01/10/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Maria Isabel CejaTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Berumen conducted an unannounced 1 year required inspection. LPA met with Maria Isabel Ceja and informed her of the reason for today's inspection. Day care hours of operation are Monday - Friday 7:30am - 5:30pm. Present during the inspection was Licensee's assistant, 5 day care children and Licensee's 2 year old daughter. Two of the children present are infants and 4 are preschoolers.

Licensee states herself and her husband, Ricardo Torres are the only adults living in the home. Licensee has three daughters, ages 9, 7, 2. A review of staff records on January 8, 2019 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.

LPA inspected the indoor and outdoor areas of the home. Off limit areas of the home are entire upstairs, laundry room and hall closet. LPA observed that the stairs are barricaded. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the children in care. The home is clean, orderly and safe for the day care children.

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, and no bodies of water. The Licensee states that she does not have weapons in the home. All detergents, cleaning compounds, poisons, medications, and other similar items are out of reach and inaccessible to children. Licensee states that she does not administer medications at this time. LPA reviewed current facility roster and fire disaster drill log. Last practiced drill was conducted and documented on 12/12/19.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: CEJA, MARIA ISABEL
FACILITY NUMBER: 354411125
VISIT DATE: 01/10/2020
NARRATIVE
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LPA reviewed Licensee's file; Licensee has current CPR & First Aid expiring on 12/2020. LPA reviewed immunization against measles. Licensee does not have proof of immunization against pertussis for herself. Licensee's assistant did not have proof of immunization against pertussis, measles. TB test. Assistant, Marisol Garcia completed the LIC 508 (Criminal Record Statement) Employee rights form and statement acknowledging requirement to report suspected child abuse (lic9108). Licensee and assistant are missing proof of completion of Mandated Reporter Training. Licensee agrees to submit proof to LPA by 01/24/2020.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours to ensure that the children are safe and 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, with a qualified assistant present.

LPA discussed Lead Safety Information (AB 2370). Chapter 676, statues of 2018, requires all child care providers, upon enrolling or re-enrolling any child, to provide the parent or guardian with written information. LPA provided Licensee with, Effects of Lead exposure flyer to handout to parents.

Safe Sleep was discussed: place infants on their backs when sleeping, use a firm sleep surface such as a mattress in a safety approved crib, keep soft bedding such as blankets, pillows, toys out baby's sleep area and ensure that pacifiers have nothing attached to them. LPA emailed Licensee link to access information.



LPA discussed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, etc.

Exit Interview was conducted. A copy of this report was provided to the Licensee at the conclusion of the inspection. Deficiencies cited on attached 809D forms.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
LIC809 (FAS) - (06/04)
Page: 3 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: CEJA, MARIA ISABEL
FACILITY NUMBER: 354411125
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/24/2020
Section Cited

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 Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. […]. This requirement is not met as evidenced by:
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Based on inspection and review of files, Licensee failed to obtain immunizations verification for herself against pertussis. Her assistant, Marisol Garcia is missing proof of immunization against pertussis & measles. This poses a potential risk to the health and safety of children in care.
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Type B
01/24/2020
Section Cited

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Application for initial license
Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.

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This requirement was not met as evidenced by: Based on inspection and review of files. Licensee's assistant, does not have evidence of current tuberculosis clearance.
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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 SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2020
LIC809 (FAS) - (06/04)
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