434408280-6-20-2019-07-CC-JTSE-BDC29M-20190620171209

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408280
Report Date: 06/20/2019
Date Signed: 06/20/2019 05:12:20 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:	MORALES, CELIA		FACILITY NUMBER:	434408280
ADMINISTRATOR:	CELIA MORALES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 254-3607
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY:	14	CENSUS: 13	DATE:	06/20/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Celia Morales		TIME COMPLETED:	05:15 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 Janet Tse met with licensee Celia Morales for an annual/random inspection. LPA explained the nature of today's inspection to Licensee. LPA observed 13 children including two school age and three infants in the home with Licensee, her assistant (IP), and her husband. Present was also Licensee's adult daughter (RM). Adults living in the home are Licensee, her husband, her adult daughter with a one-year-old child. LPA toured the indoor and outdoor of the home. LPA observed a covered fish tank in the indoor play area. Off limits indoor: dining room, kitchen, living room, three bedroom, and one bathroom. Licensee stated there is no firearms/weapons in the home. LPA observed a dog in the home. Licensee stated the dog is vaccinated. Sharp objects, medicines, poisons and cleaning supplies were inaccessible to the children. Backyard is fenced. Off limits outdoor: the locked/fenced off area in the back yard which includes two storage sheds. LPA also observed a bird cage with six birds in the fenced off limits area. LPA reminded licensee that she can only have 14 children according to her license. Fire extinguisher is size 3A40BC and filled. Smoke and carbon monoxide detector is operable. Home is clean and orderly with heating and ventilation for safety and comfort. LPA observed sufficient materials, toys, and play equipment for the day care children. Telephone is in working order. Children were supervised on the visit and LPA went over substitute options. LPA also discussed if licensee transports children, they are never to be left in parked vehicles. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 06/17/2019 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 observed the roster of the children is not current. Eight children's files were reviewed. LPA observed in Facility Evaluation Report dated 06/20/2019 to be continued on next page:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

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: MORALES, CELIA	FACILITY NUMBER: 434408280
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/20/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/02/2019 Section Cited CCR 102417(g)(8)	1 2 3 4 5 6 7	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 evidenced by: LPA observed the roster of the children is not current.	1 2 3 4 5 6 7	Licensee shall forward a copy of the current roster of the children to LPA by 07/02/2019 due date.
	8 9 10 11 12 13 14	This poses a potential risk to the Health, Safety, or Personal Rights of 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: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

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: MORALES, CELIA	FACILITY NUMBER: 434408280
	VISIT DATE: 06/20/2019

NARRATIVE

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Facility Evaluation Report dated 06/20/2019 to be continued from previous page:

each child’s record has a copy of the emergency information card that contains all of the information specified by regulation. LPA observed that Licensee, her assistant (IP), and her husband has current Pediatric CPR/1^st Aid expiring 07/03/2019, 09/23/2019, and 07/03/2019 respectively.

Licensee was given a list of the current forms for child care. Website to download forms and to review regulation: www.ccld.ca.gov. LPA discussed the immediate civil penalties for Zero Tolerance of $500, and an ongoing $100 per day per violation continues until the violation(s) is corrected. LPA also discussed the Healthy Beverage Act and AB633 requirements for type A violation. SB792 Immunization Requirements was also discussed. LPA observed the required immunization records for licensee, her husband, and her assistant were in file. Incidental Medical Services were discussed with the licensee. The licensee is not providing IMS (Incidental Medical Services) 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. Information regarding Safe Sleep Practice and Lead Poisoning was provided to Licensee.

Deficiency was cited. Notice of site visit was issued and must be posted for 30 days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

LIC809 (FAS) - (06/04)

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