354414449-9-18-2019-07-CC-SCES-BG5S86-20190918133836

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 354414449
Report Date: 09/18/2019
Date Signed: 09/18/2019 01:38:47 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:	CARRILLO, ALEJANDRA		FACILITY NUMBER:	354414449
ADMINISTRATOR:	CARRILLO, ALEJANDRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 801-4960
CITY:	HOLLISTER	STATE: CA	ZIP CODE:	95023
CAPACITY:	14	CENSUS: 0	DATE:	09/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Alejandra Carrillo		TIME COMPLETED:	01:45 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 Analysts (LPAs) Susy Cervantes and Fermin Campos-Jaramillo conducted an unannounced annual random inspection to the home today. LPA met with Alejandra Carrillo, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM. The adults that reside in the home are the Licensee, her husband Rene Cortes with two minor children ages 9 and 15. LPAs observed there were no children in care today. Licensee's certifications for CPR and First Aid card are current and will expire on 07/03/2020. . LPAs toured the indoor and outdoor areas of the home during today's inspection. LPAs obtained a copy of the Child Care Facility Roster during today's inspection and it is current. Licensee has documented a fire drill during the last six months. Last fire drill was documented on 06/12/2019. The Licensee has a working telephone in the home. LPAs observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: Three bedrooms, one bathroom and the laundry area located in a locked closet. LPAs observed there are no stairs inside the home. Off limits areas outside: Right side of mobile home is a parking port. Licensee has a parrot and a small dog in the home licensee stated it is vaccinated. LPAs observed a fully charged 2A10BC fire extinguisher that was last serviced on January 7, 2019 and at least one working smoke detector. LPAs observed the home has a working carbon monoxide detector and no bodies of water. LPAs observed there are no wall heaters. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. LPAs discussed Incidental Medical Services (IMS) with the Licensee, she is currently not providing IMS. According to the SB792 Licensee has, in her file, proof of immunization for measles, pertussis and influenza. Report dated 09/18/2019 continues in page 2.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019

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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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: CARRILLO, ALEJANDRA	FACILITY NUMBER: 354414449
	VISIT DATE: 09/18/2019

NARRATIVE

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Report dated 09/18/2019 continues from page 1.

A review of staff records on 09/16/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPAs 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.
LPAs reviewed 3 children’s files. Children’s immunization records are documented, maintained, and updated in form PM286. LPA observed Notification of Parents’ Rights is in each child’s file.
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 that in absence of a helper her license becomes capacity and ratio of 8 children only (small FCCH license) and ratio (age of the children) must be observed. The Licensee states that she transports 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 discussed the requirements of AB 633 whenever a Type A deficiency is cited. LPA also discussed "zero tolerance" related regulations with the Licensee.
LPA advised licensee of the required "mandated reporter" training that all Licensees will be required to complete starting January 1, 2018. www.mandatedreporterca.com. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information on the online training. LPA advised licensee of the pending Department regulation update re: Safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.
Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made
No deficiencies were cited during today's inspection. Exit interview was conducted with licensee.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019

LIC809 (FAS) - (06/04)

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