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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440709561
Report Date: 07/02/2024
Date Signed: 07/02/2024 12:51:32 PM


Document Has Been Signed on 07/02/2024 12:51 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 - INFANTSFACILITY NUMBER:
440709561
ADMINISTRATOR:ROSA MENDOZAFACILITY TYPE:
830
ADDRESS:234 MONTECITO STREETTELEPHONE:
(831) 722-3737
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:8CENSUS: 2DATE:
07/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rosa MendozaTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Cortney Nelson and Jennifer 'Jen' Beehler, met with Site Director, Rosa Mendoza, and explained purpose of visit. Upon arrival, LPAs were admitted into the facility by the Site Director.

During today's visit, LPAs reviewed staff files and observed that one staff member (S1) is missing proof of immunizations. LPAs advised that immunization records shall be maintained for staff members and show proof of immunity to measles, pertussis, and flu (or a signed declination).

Additionally, LPAs observed that only S1 was present working with the infants today as another staff member called out. LPAs advised that infants shall be visually supervised at all times and inquired how S1 will take a lunch or other breaks throughout the day. Rosa states that no breaks will be taken today. LPAs advised that in the future, a substitute shall be available in case of emergency and that Rosa may consider reaching out to sub agencies or other resources, such as members of the board for the facility.

As a result of today's inspection, a deficiency was cited, see LIC809-D.

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

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024
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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Document Has Been Signed on 07/02/2024 12:51 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 - INFANTS
FACILITY NUMBER: 440709561

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/12/2024
Section Cited
HSC
1596.7995(a)(1)

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(a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles...

This requirement was not met as evidenced by:
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The Site Director shall submit proof of immunity to measles, pertussis, and influenza (or declination), for one staff member to the Department by 7/12/2024.
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The Site Director did not maintain proof of measles, pertussis, and influenza for one staff member, which poses a potential risk to the health, safety, and personal rights of 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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024
LIC809 (FAS) - (06/04)
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