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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408286
Report Date: 12/06/2019
Date Signed: 12/06/2019 11:08:02 AM

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, OLGAFACILITY NUMBER:
434408286
ADMINISTRATOR:OLGA MORALESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 847-7347
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 4DATE:
12/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nancy MoralesTIME COMPLETED:
11:15 AM
NARRATIVE
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LPA Deanna Villagrana met with licensee's daughter Nancy Morales for an unannounced annual/random inspection. LPA explained the nature of today’s inspection to her. Present were licensee's adult daughter with her two children and two day care children. Daughter stated licensee's adult son was upstairs. Daughter stated licensee Olga Morales had to go to San Jose to drop off some papers. Olga arrived an hour later. Days and hours of operation are Monday to Sunday, 4:00am to 12:00am. The adults that reside in the home are licensee, her husband, two adult sons, adult daughter and two grandchildren ages 4 years old and 6 months. In the studio above the garage lives her adult daughter with her husband and 4 year old daughter.

A review of staff records on 11/19/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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.

Upon arrival, LPA could see a child at the front door trying to open it. Nancy came inside the home from a back door. When Nancy answered the door, LPA asked her if she was outside. Nancy stated yes. LPA observed stairs were not barricaded. LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPA observed a barricaded fireplace in the home. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items inside the home are stored inaccessible to children. LPA observed a fully charged 2A10BC fire extinguisher. LPA observed a working smoke and carbon monoxide detector. Nancy states there are no weapons/firearms in the home. Off limit areas indoor: three upstairs bedrooms, one bathroom and a downstairs bedroom. The kitchen is barricaded and inaccessible to children. There are no bodies of water. Backyard is fenced. Off limits outdoor: detached garage along with a studio that is built above the garage. Nancy states there are two dogs that stay upstairs and have vaccinations.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
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: MORALES, OLGA
FACILITY NUMBER: 434408286
VISIT DATE: 12/06/2019
NARRATIVE
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LPA observed Nancy's CPR and First Aid certification expired on 10/13/2019. Olga's CPR and First Aid expires on 02/24/2020. LPA explained to Olga at least one person in the home must have a current CPR and First Aid certification when caring for children. LPA observed a current roster of the children and a fire and disaster drill log which was last completed in 09/09/2019. LPA reviewed two children's files and observed all forms are completed and children have current immunization records. Licensee states she does not have day care insurance. LPA observed LIC282 in each child's file. LPA discussed SB792 Immunization Requirements and observed licensee and Nancy have current immunizations against pertussis, measles and influenza. Licensee observed licensee and Nancy have completed Mandated Reporter Training in November 2017 and must complete it again.


Supervision of children was discussed with 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. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time. Licensee understands if she transports children via vehicle, children cannot be left in parked vehicles unattended at any time.
LPA discussed Zero Tolerance with $500 immediate civil penalty. An ongoing $100 per day per violation continues until the violation(s) is corrected. LPA discussed the requirements of AB633 to licensee and provided her the AB633 fact sheet and licensee understands the requirements. 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.
LPA reminded the Licensee that effective January 1, 2019 Assembly Bill 2370 requires that all licensed homes 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 Licensee. Safe sleep information & handout was also discussed with the Licensee.

The following type B deficiencies were cited on the attached page (809-D). Appeal rights were provided to the Licensees prior to the conclusion of today's inspection. 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.

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

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
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: MORALES, OLGA
FACILITY NUMBER: 434408286
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/06/2019
Section Cited

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102417(g)(3) Operation of a Family Child Care Home. Where children are less than five years old are in care, stairs shall be fenced or barricaded. This requirement was not met as evidenced by LPA
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observed stairs were not barricaded.
This poses a ptential risk to the Health, Safety or Personal Rights to children in care.
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Type B
01/06/2020
Section Cited

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102416(c) Personnel Requirements. The Licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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This requirement was not met as evidenced by LPA observed Nancy's CPR and First Aid certification expired on 10/13/2019. This poses a potential risk to the Health, Safety Personal Rights risk to children in care.
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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 SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3