434411536-6-30-2021-07-CC-DVIA-C4GMW9-20210630095800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434411536
Report Date: 06/30/2021
Date Signed: 06/30/2021 09:58:10 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:	OURRICARIET, LARAY		FACILITY NUMBER:	434411536
ADMINISTRATOR:	OURRICARIET, LARAY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 683-9237
CITY:	SAN MARTIN	STATE: CA	ZIP CODE:	95046
CAPACITY:	14	CENSUS: 0	DATE:	06/30/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Laray Ourricariet		TIME COMPLETED:	10:10 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	LPA Deanna Villagrana met with licensee Laray Ourricariet for required 1 year visit. LPA explained the nature of today’s inspection to her. Present were licensee and licensee's daughters, and assistant. Licensee states she has not had kids since June 4, 2021. Days and hours of operation are Monday to Friday, 8:00am to 2:00pm. The adults that reside in the home are licensee, her husband, and two adult daughters. A review of staff records on 06/28/2021 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. LPA toured the indoor and outdoor areas of the home during today’s inspection. The daycare is in the room that was previously a garage and was approved for daycare. LPA observed that the daycare is clean and orderly, with heating and ventilation for safety and comfort of the children. LPA did not observe barricaded stairs or fireplace in the daycare. 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 detector and a working carbon monoxide detector. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: entire home. There are no bodies of water. Backyard is fenced. Off limits outdoor: side yards, deck, and fenced off areas with a locked storage. LPA observed one dog in the home. Licensee states dog stays on the deck in the backyard. LPA observed licensee has a current CPR and First Aid certification that expires 07/01/2022. Licensee and assistant completed Mandated Reporter training.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

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: OURRICARIET, LARAY	FACILITY NUMBER: 434411536
	VISIT DATE: 06/30/2021

NARRATIVE

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LPA observed a current roster of the children and a fire and disaster drill log which was last completed on May 18, 2021. LPA reviewed three children's files and observed all forms are completed and children have current immunization records. LPA observed daycare is insured with DCI and it expires on 09/08/2021. LPA discussed SB792 Immunization Requirements and observed licensee's and her assistant's immunization records in file.

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 a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) 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.

No 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: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

LIC809 (FAS) - (06/04)

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