434415847-6-21-2021-07-CC-SYIP-C47MPP-20210621094727

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415847
Report Date: 06/17/2021
Date Signed: 06/21/2021 09:47:35 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:	AVALOS, MARIA DEL CARMEN		FACILITY NUMBER:	434415847
ADMINISTRATOR:	AVALOS, MARIA DEL CARMEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 346-2243
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 8	DATE:	06/17/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Maria Del Carmen Avalos and Juana Cerna		TIME COMPLETED:	12:05 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 Required 1 Year inspection. LPA met with Licensee Maria Del Carmen Avalos and her daughter, Juana Cerna, who helps with the family child care home. Present during today's inspection where 8 children, whom 1 was infant age. There is a board for required positing. The hours of operation are Monday though Friday 7AM to 5PM. There is working phone in the home. LPA toured the home. The off-limit areas of the home are the kitchen, 1st living room, the 2 bedrooms, bathroom adjacent to the bedroom, master bedroom, garage, and the left side of the yard. LPA reminded Licensee to ensure that doors are closed to the off-limit areas. There are fireplaces in the home, which are barricaded. All disinfectant, cleaning supplies, and other items that are dangerous to children were inaccessible to children. LPA reminded Licensee that any bottles with cleaning supplies and Feebrez need to be inaccessible to children. The home was observed to be clean. All toys and equipment were observed to be in good condition and age-appropriate. LPA discussed with Licensee about documentation of when any children are under age 2 are sleeping. There were no baby walkers observed during today's inspection. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 01/2021. Licensee understands that fire/disaster drills need to be conducted every 6 months and documented. Licensee stated that there is no weapons, such as firearms, stored in the home. The backyard is used and is fenced. There is a swing set, which is anchored to the ground. -------------------CONTINUES ON 809 DATED 06/17/2021 PAGE 2--------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

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: AVALOS, MARIA DEL CARMEN	FACILITY NUMBER: 434415847
	VISIT DATE: 06/17/2021

NARRATIVE

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-------------------CONTINUATION OF 809 DATED 06/17/2021 PAGE 1---------------------------
LPA observed that there was a wading pool in the backyard with water. Licensee stated that they just came back inside. Licensee dumped out the water in the wading pool during today's inspection. LPA reminded Licensee that any water in wading pools need to be dumped out after each use. LPA also reminded Licensee to close gates that lead to the off-limit areas. There were no other bodies of water observed during today's inspection.

Licensee stated that she does not transport children, but understands that children cannot be left alone and unattended in parked vehicles. Licensee also stated that she is currently not providing Incidental Medical Services (IMS).

A copy of the facility roster was obtained. Licensee stated that she will update facility roster and send a picture to Licensing. 8 children's files were reviewed. The records reviewed include, but not limited to Emergency Information Card.

Licensee and her daughter's file were also reviewed. Licensee and her daughter both completed the Mandated Reporter Training on 03/30/2021. Immunization records for measles and pertussis are on file for both Licensee and her daughter. Her daughter completed her CPR/1st Aid on 02/14/2021, but is still waiting to see if it is EMSA approved.

The adults living in the home are Licensee, her spouse, and her daughter. All adults have cleared criminal record, child abuse index, or exemption, and TB test clearance. 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.

In the areas evaluated during today's inspection, a technical violation was issued. An exit interview was conducted where this report and technical violation were discussed with Licensee Maria Avalos. A Notice of Site Visit has been issued and must be posted for 30 days.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

LIC809 (FAS) - (06/04)

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