434408286-5-15-2019-07-CC-FCJO-BC7PAM-20190515110859

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408286
Report Date: 05/15/2019
Date Signed: 05/15/2019 11:09:06 AM

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:	MORALES, OLGA		FACILITY NUMBER:	434408286
ADMINISTRATOR:	OLGA MORALES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 847-7347
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 5	DATE:	05/15/2019
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Olga Morales		TIME COMPLETED:	11:15 AM

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), Fermin Campos-Jaramillo, met with Licensee, Olga Morales, and conducted an unannounced case management inspection today. Licensee was in the home with four children including 3 preschool age and 2 infants when LPA arrived. Licensee stated that the adults residing in the home are: Licensee, her spouse Jose, her adult son Uriel, her adult daughter Daisy, and her son in law Gabriel. Days and hours of operation are Monday to Saturday from 5:00 AM to 12:00 AM. Licensee's helper is Berenice Perez, present during the inspection. LPA observed the CPR and First Aid certification for the Licensee is current until 2/24/2020. Licensee has a board in her FCCH and licensing documents are posted included the stipulations. LPA toured the indoor and outdoor areas of the home. LPA observed that the fire drills are conducted at least once every six months and the last fire drill was documented on 03/15/2019. LPA requested a current children's roster. Children's roster is current as of today. LPA reviewed five children's files and they are complete. The Licensee has a working land line telephone. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters inside the home. LPA observed the detached garage is off limits and it is used for storage and laundry area. LPA observed there are stairs in the home and are barricaded from the bottom. Licensee stated there are two small pets in the home, and they are kept in the off limits second floor of the home and Licensee stated they are vaccinated. LPA observed a fully charged 2A10BC fire extinguisher. LPA observed there is at least one working smoke detector and one carbon monoxide detector. The backyard is fenced and licensee uses it as playground for the children in care. LPA observed there are no bodies of water in the home. The Licensee states that she does not have any weapons in the home. All poisons, detergents, cleaning supplies, medications, and other similar items are stored inaccessible to children. Off limits area inside the home is all the second floor. Off limits area outside the home is the detached garage. REPORT DATED 5/15/2019 CONTINUES IN PAGE 2.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019

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, OLGA	FACILITY NUMBER: 434408286
	VISIT DATE: 05/15/2019

NARRATIVE

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CONTINUATION OF REPORT DATED 5/15/2019.

The home has a living space constructed on top of the garage where another licensee's daughter (Daisy) lives with her husband (Gabriel) both have received criminal records clearance. Licensee is aware that her son Bryan who recently turned 18 years old (DOB 5/10/2001) must submit a livescan form and obtain a criminal records clearance or exemption. Licensee was informed that The Department will verify that Bryan obtains a criminal records clearance or exemption before June 09. 2019.
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. 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 months period. A review of staff records dated 5/14/2019 indicates that all the other adults residing in the home (excepting Bryan) or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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 prevents them from returning to the home or having contact with children in care.

Incidental Medical Services (IMS) policy was discussed with Licensee.
Supervision of children was discussed with licensee and she understands that she must be present in the home during the day care hours and ensure that the children are supervised at all times. 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 without a helper her licensee capacity will be reduced to the capacity of a Small FCCH license and ratio shall be observed too.
Licensee states that her helper (Nancy) transports children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.
Department website: http://ccld.ca.gov provided to Licensee.
Licensee has in file proof of having immunization for pertussis, measles and influenza for her and for her helpers included Berenice according with the SB792.

****************************Report dated 5/15/2019 continues in page 3.*******************************

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019

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, OLGA	FACILITY NUMBER: 434408286
	VISIT DATE: 05/15/2019

NARRATIVE

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Report dated 5/15/2019 continues from page 2.

Licensee and her helper Nancy have taken the Mandated Reporter training on 11/04/2017 and 11/05/2017 respectively. Licensee understands that her other helper, Berenice, shall complete the Mandated Reporter training whenever the training becomes available in Spanish. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information. LPA reminded Olga to continue posting a copy of the Stipulation and the attached Accusation until Licensee obtains a regular FCCH license. LPA observed the form LIC9224 has been maintained in the corresponding child's file. LPA discussed Zero Tolerance deficiencies with licensee. LPA discussed the requirements of AB633 and licensee understands the requirements.
LPA advised applicant of the pending Department regulation update re: Safe sleep for infant children. LPA referred the applicant to the Department website: www.ccld.ca.gov for additional information.
There are no deficiencies cited in today's inspection. Appeal Rights provided to the Licensee.
Exit interview conducted was with the Licensee in Spanish.

NOTICE OF SITE INSPECTION WAS PRINTED AND HANDED TO LICENSEE AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019

LIC809 (FAS) - (06/04)

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