430757817-11-1-2019-07-CC-SCES-BHHR77-20191101124553

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430757817
Report Date: 11/01/2019
Date Signed: 11/01/2019 12:46:04 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:	VEGA, MARIA		FACILITY NUMBER:	430757817
ADMINISTRATOR:	VEGA, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 270-5992
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95122
CAPACITY:	14	CENSUS: 11	DATE:	11/01/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Maria Vega		TIME COMPLETED:	01:00 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	LPA Susy Cervantes met with licensee Maria Vega for an annual/random inspection and explained the nature of today’s visit. Present were Licensee, her husband/assistant Jose, her daughter/assistant Cindy, and her assistant Lorena with 11 children of which two are infants and nine are preschool age. Adults living in the home are Licensee, her husband and granddaughter Amanda. Days and hours of operation are Monday through Friday, 7:00 am to 5:00 pm. . A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 10/31/19 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensee shall immediately remove the individual and prevent them from returning to the home or having contact with children in care. LPA toured the inside and outside of the home. LPA observed no fireplace and no wall heaters. LPA observed no stairs. Off limits indoor: Kitchen, two bathrooms and 2 bedrooms. There are no bodies of water. Licensee stated there are no firearms/weapons in the home. LPA observed a 3A40BC fire extinguisher that was last serviced on 8/23/19. Smoke detector and Carbon Monoxide detectors are operable. LPA observed sufficient materials, toys, and play equipment for the children in care as well as safe healthful, and comfortable accommodations, furnishings, and equipment. Telephone is in working order. Medicines, poisons and cleaning supplies are inaccessible to the children and stored in the lock shed outside and the top kitchen cabinets. Backyard is fenced. There are no pets. Off limits outdoor: left side of yard (fenced) and a locked shed. Continues on report dated 11/1/2019

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019

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: VEGA, MARIA	FACILITY NUMBER: 430757817
	VISIT DATE: 11/01/2019

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
26
27
28
29
30
31
32

Continuation of report dated 11/1/2019
LPA reminded licensee that she can only have 14 children according to her license. Children were supervised during the visit and LPA went over substitute options. Licensee stated that she does transports children, LPA reminded Licensee that children are never to be left in parked vehicles.

LPA observed a roster of the children that is not current. A fire and disaster drill log was observed that was last conducted on 1024/19. LPA reviewed 11 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. LPA observed that the Licensee and assistants have completed Mandated Reporter training on 4/3/18 (Maria), 4/4/18 (Jose and Lorena), 9/19/19 (Cindy). Licensee and Assistants have Pediatric CPR/1^st Aid expiring 7/13/21 (Maria), 8/11/20 (Lorena), and 8/26/21 (Cindy). LPA reviewed three employee files and observed licensee and employees have all needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza (decline statement) as well as TB testing.

Incidental Medical Services (IMS) policy was discussed with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing IMS at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

Licensee was reminded that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. LPA discussed the immediate civil penalties for Zero Tolerance of $500. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. Safe sleep was discussed with the Licensee and Guide to Safe Sleep information was provided to the licensee. Department website: http://ccld.ca.gov provided to Licensee.
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.
An exit interview was conducted in Spanish with Licensee. LPA reviewed deficiencies, plans of correction, and licensee was given appeal rights. Type B deficiencies were cited during today's inspection.

Notice of site visit must remain posted for 30 days

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019

LIC809 (FAS) - (06/04)

Page: 2 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: VEGA, MARIA	FACILITY NUMBER: 430757817
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/01/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/15/2019 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement was not met as evidence by: LPA observed a roster of
	8 9 10 11 12 13 14	the children that is not current. This poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3