440709560-8-24-2022-07-CC-CNEN-CHLVF5-20220824162321

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 440709560
Report Date: 08/24/2022
Date Signed: 08/24/2022 04:23:35 PM

Document Has Been Signed on 08/24/2022 04:23 PM - It Cannot Be Edited

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:	PAJARO VALLEY CHILDREN'S CENTER		FACILITY NUMBER:	440709560
ADMINISTRATOR:	ROSA MENDOZA		FACILITY TYPE:	850
ADDRESS:	234 MONTECITO STREET		TELEPHONE:	(831) 722-3737
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	24	CENSUS: 7	DATE:	08/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Rosa Mendoza		TIME COMPLETED:	04:35 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), Cortney Nelson, met with Site Director, Rosa Mendoza, for an unannounced Required- 1 Year Inspection. LPA was granted access to the facility by infant staff member, Magdalena, and conducted COVID risk assessment questions. LPA toured both indoors and outdoors during today's inspection. Upon arrival, there were 7 preschool-age children and 1 staff member present, which is compliant with the facility license capacity and ratio requirements. LPA observed all required postings near the entrance to the facility. Hours of operation for the facility are Monday – Friday, 7:00AM-5:30PM. LPA reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. Sign-in/out was observed to be completed with full legal signature and time of day. The last fire/disaster drill was conducted on 8/1/2022, which is compliant with the six-month requirement for facilities. LPA observed a fully charged 2A10BC fire extinguisher (last serviced 11/2020), functioning smoke detector and carbon monoxide detector. There is a second 2A10BC fire extinguisher located in the kitchen, last serviced 11/2022. LPA advised fire extinguishers are serviced annually. Site Director states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. The Site Director states that there are no weapons or firearms on the premises. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers, Section 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022

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: PAJARO VALLEY CHILDREN'S CENTER	FACILITY NUMBER: 440709560
	VISIT DATE: 08/24/2022

NARRATIVE

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Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. The floors were clean and free of tripping hazards. Drinking water is readily available for children in the facility via water dispensers and water bottles from home labeled with the children’s names. Staff and children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom, not utilized by the children, which an isolated child can use if necessary. The Site Director has a working telephone in the facility.

The outdoor area of the facility was inspected and observed to be fenced in. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (tanbark) to absorb falls. During today's inspection, a child entered the kitchen unattended. LPA recommended that outside area is fenced while only one teacher is present with preschool children to ensure visual supervision. The outside space is split into two areas on either side of a patio that children are able to access freely. One teacher outside is unable to visually supervise all areas of the outside space. LPA additionally advised cleaning of the playground structure which has visible build up along the top of the structure and to remove rusted trucks from the sandbox. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by building overhang.

The facility no longer provides any food to the children. Site Director states that this change was implemented during the pandemic as originally parents would bring snacks to be shared with children in attendance. LPA advised that parent handbook/plan of operation be updated to reflect changes in the program. LPA additionally observed food throughout the kitchen with expired best by dates and advised that Site Director remove all expired food from the facility. No menu was observed during todays inspection.

7 children’s files were reviewed during today’s inspection and all required documents were present. 3 staff files (Site Director & 2 teachers) were reviewed and most required documents were present. The Site Director has current CPR/First-Aid that expires 7/12/2023 and Mandated Reporter training that expires 3/24/2023. LPA reminded the Site Director that both trainings must be renewed every 2 years.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022

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: PAJARO VALLEY CHILDREN'S CENTER	FACILITY NUMBER: 440709560
	VISIT DATE: 08/24/2022

NARRATIVE

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The Site Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA also informed Site Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The Site Director understands that she shall be on the premises during the hours the center is in operation and that children at the center shall be visually supervised at all times. LPA reminded Site Director that there shall be at least one person with valid CPR and First-Aid certifications on site at all times or present during off site activities, such as field trips.

Exit interview conducted and report was reviewed with the Site Director, Rosa Mendoza.

As a result of today’s inspection, deficiencies were cited, see 809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

The following documents were requested to be updated and submitted:
-Administrative Organization (LIC309)
-Application for Child Care Center (LIC200A)
-Updated Board Members for PVCC
-Updated Plan of Operation/Parent Handbook

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/24/2022 04:23 PM - It Cannot Be Edited

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: PAJARO VALLEY CHILDREN'S CENTER	FACILITY NUMBER: 440709560
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(a)

Buildings and Grounds

(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above as rusted toys were located in the sandbox and playground structure has visible dirt/staining, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/31/2022
	Plan of Correction
1 2 3 4	Site Director will remove rusted toys from the play area for children and clean play structure for children by 8/31/2022.

Type B

Section Cited

CCR

101229(a)(1)

Responsibility for Providing Care and Supervision

(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above during outside play time when a child entered the kitchen unannounced, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/31/2022
	Plan of Correction
1 2 3 4	Site Director will submit plan of action (by 8/31/2022) to ensure that children are visually supervised while outside, especially with only one teacher present. LPA walked with Site Director and gave suggestions for possible additional fencing or baby gate to lessen area needing to be watched.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 08/24/2022 04:23 PM - It Cannot Be Edited

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: PAJARO VALLEY CHILDREN'S CENTER	FACILITY NUMBER: 440709560
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(a)(12)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above for one staff member out of four present today, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/02/2022
	Plan of Correction
1 2 3 4	Site Director will submit proof of negative TB test for one staff member by 9/2/2022. If it is an old TB test, results should not be older than one year prior to staff employment at the facility.

Type B

Section Cited

CCR

101227(a)(1)

Food Service

(1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. Each meal shall include, at a minimum, the amount of food components as specified by Title 7, Code of Federal Regulations, Part 226.20, (Revised January 1, 1990) Requirements for Meals, for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above as the kitchen fridge and pantry possessed expired food products, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/29/2022
	Plan of Correction
1 2 3 4	Site Director will submit photos of pantry cabinets and fridge with all expired goods removed from the facility. Additionally, Site Director will update Plan of Operation and Parent Handbook to reflect the changes in the program, not offering food from the facility to children enrolled.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022

LIC809 (FAS) - (06/04)

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