434407880-8-13-2019-07-CC-SYIP-BEZTCU-20190813143720

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434407880
Report Date: 08/13/2019
Date Signed: 08/13/2019 02:37:33 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:	LUCERO, PATRICIA		FACILITY NUMBER:	434407880
ADMINISTRATOR:	LUCERO, PATRICIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 846-2823
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 10	DATE:	08/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:34 PM
MET WITH:	Patrica Lucero		TIME COMPLETED:	02:50 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) Samantha Yip conducted an unannounced annual random inspection. LPA met with Licensee Patricia Lucero and explained the reason for the inspection. Present during the inspection were Licensee, her brother, and 10 children, whom one was infant age. The hours of operation are Monday through Friday 7AM to 530PM. There is working phone. LPA toured the inside and the outside of the home with Licensee. The off-limit areas of the home are the master bedroom, all four bedrooms, the garage, the right and left side of the backyard. There are no stairs in the home. There is fireplace in the home, which is barricaded to prevent access by children. Disinfectants, cleaning supplies, and other items that are dangerous to children in care were stored inaccessible. LPA observed there is sufficient amount of toys and equipment for children. Furniture and equipment, such as tables, chairs, napping mats, play yard, and play structure, were in good condition. LPA observed the bathroom for children's use. LPA observed a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 08/2019. Licensee stated there are no weapons, such as firearms, stored in the home. The backyard is used and is fenced. There is play structure that is anchored to the ground. LPA reminded Licensee to ensure that the gates leading to the off-limit area are closed before children go outside. LPA also discussed with Licensee about sweeping the backyard for anything that could pose a risk to the children, such as loose screws. LPA did not observe any bodies of water during today's inspection. ------------------continue on 809 dated 08/13/2019 page 2-------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

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: LUCERO, PATRICIA	FACILITY NUMBER: 434407880
	VISIT DATE: 08/13/2019

NARRATIVE

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----------------continuation of 809 dated 08/13/2019 page 1------------------------------------

Licensee does transport children at this time. Licensee understands that children cannot be left alone and unattended in park vehicles. LPA provided Licensee with the California Car Seat Law Changes.

LPA reviewed children's file during today's inspection. The records reviewed include but not limited to the parent's rights and Affidavit Regarding Liability Insurance For Family Child Care Home. LPA talked about auditing the children's file to ensure that all forms are filled out.

Licensee stated that she completed the Mandated Reporter Training and will ensure that she has a copy the certificate on file. Licensee and her brother do have immunization records for measles and pertussis. LPA obtained a copy of Licensee's and her brother's immunization records. Licensee and her brother's CPR/1st Aid expires on 06/12/2020. Licensee's brother has not completed the Mandated Reporter Training and will completed Mandated Reporter Training within 2 weeks.

LPA discussed with Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at http://www.mandatedreporterca.com.

Adults, who are over the age of 18, are Licensee and her three adult children. All adults living the home have cleared criminal record and child abuse index. 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. 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.
---------------continues on 809 dated 08/13/2019 page 3-------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: LUCERO, PATRICIA	FACILITY NUMBER: 434407880
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/13/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/23/2019 Section Cited HSC 102421	1 2 3 4 5 6 7	Child's Records. The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evident by:	1 2 3 4 5 6 7	By POC 08/23/2019, Licensee will send proof of signed parent's right notice and affidavit regarding liability insurance to Licensing office.
	8 9 10 11 12 13 14	Based on record reviews, LPA observed that there were children in care who did not have notification of parent's rights and/or Affidavit Regarding Liability Insurance For Family Child Care Home signed. This poses a potential risk to 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
	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: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

Page: 4 of 4

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: LUCERO, PATRICIA	FACILITY NUMBER: 434407880
	VISIT DATE: 08/13/2019

NARRATIVE

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Licensee stated that she does not have any children in care who require Incidental Medical Services (IMS). When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Home Section 102417. 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.

LPA also reviewed Safe Sleep information. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

In the areas that were evaluated, a Type B deficiency have been cited. An exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were discussed with Licensee.

A NOTICE OF SITE VISIT WAS ISSUE AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

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