440709561-8-24-2022-07-CC-CNEN-CHLVGY-20220824162618

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 440709561
Report Date: 08/24/2022
Date Signed: 08/24/2022 04:26:31 PM

Document Has Been Signed on 08/24/2022 04:26 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 - INFANTS		FACILITY NUMBER:	440709561
ADMINISTRATOR:	ROSA MENDOZA		FACILITY TYPE:	830
ADDRESS:	234 MONTECITO STREET		TELEPHONE:	(831) 722-3737
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	8	CENSUS: 3	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 the staff member, Magdalena, and completed COVID risk assessment questions. LPA toured both indoors and outdoors during today's inspection. Upon arrival, there were 3 infants and 1 teacher 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, 8:30AM-3:30PM. LPA reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. 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). The infant room does not have a functioning smoke detector, however there is a functioning smoke detector located in the preschool classroom. 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)

Page: 1 of 5

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
	VISIT DATE: 08/24/2022

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
26
27
28
29
30
31
32

Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and safe for day care infants. Infant room at the facility is physically separate from the preschool component. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. Toys are safe and do not have sharp edges or small parts that may pose a choking hazard. Infant changing table was observed to be padded, within arms reach of a sink, in good repair and safe condition. There are 8 cribs available to be used by the infants that free from loose articles, covered with a fitted sheet, and there are no objects hanging above or attached to the crib. The floors are clean and free of tripping hazards. LPA observed that facility needs waste container with tight-fitting lid for solid waste. LPA additionally observed inclined sleeper for infants and advised that it is immediately removed from the facility as it is not allowed in child care facilities.

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.

All infants have current Needs and Services plan that has been updated quarterly. The Site Director understands that all formula and bottles provided should be labeled individually with the child’s name and the date. LPA advised that bottles provided include date as during today's inspection, bottles were observed to only have the child's name.

Infant Safe Sleep regulations (PIN 20-24-CCP) were discussed with the Site Director, including the Individual Infant Sleeping Plan (LIC9227). LPA reminded Site Director that infants up to 12 months of age should be placed on their back to sleep, that cribs should be free of all loose articles and hanging objects, and that infants should not be swaddled. Infants should be supervised while sleeping and documentation of sleep checks every 15 minutes should remain in the infant’s file. Documentation should include the time of the check, the infant’s physical condition, and initials of the staff member checking on the infant. Infants are considered children under the age of 2 years old.

The outdoor area of the facility was inspected and observed to be fenced in and physically separated from space utilized by the preschool component. LPA observed play equipment was age-appropriate and surrounded by grass. Play structure was observed to be visually dirty and LPA advised it be cleaned before infants utilize it. Sandbox located in infant area needs to be cleaned out and the fence appears to need repair. No outdoor bodies of water were observed during today’s inspection.

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)

Page: 2 of 5

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
	VISIT DATE: 08/24/2022

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
26
27
28
29
30
31
32

3 infant files were reviewed during today’s inspection and most required documents were present. 2 staff files (Site Director and 1 teacher) were reviewed and all required documents were present. The Site Director has current CPR/First-Aid that expires 7/12/2023 and current Mandated Reporter Training that expires on 3/24/2023. LPA reminded Site Director that both trainings must be renewed every 2 years.

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.

The Site Director understands that she shall be on the premises during the hours the center is in operation and that infants 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:
-Application for Child Care Center (LIC200A)

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)

Page: 3 of 5

Document Has Been Signed on 08/24/2022 04:26 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: 08/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101239(f)(1)

Fixtures, Furniture, Equipment and Supplies

(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof. 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 waste container for infants that does not have a tight fitting lid, 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 obtain new waste container for solid waste that has a tight-fitting lid that is in good repair, leak proof, and rodent proof by 8/29/2022. Photo of new bin will be submitted to Licensing.

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 for outside area with infant playground structure that has visible dirt all over it and fence is in dissarray, 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 photos of cleaned plastic structure for infants and repaired fencing for the infant outside area by 9/2/2022.

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 04:26 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: 08/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.2(f)

Outdoor Activity Space

(f) Sandboxes shall be inspected daily and kept free of hazardous foreign materials. 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 the sandbox which has visibly noticable foreign materials and doesnt appear maintained for infants, 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 clean out sandbox for foreign materials and clean for use by infants in care by 9/2/2022.

Type B

Section Cited

CCR

101419.2(b)(2)

Infant Needs and Services Plan

(b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference. 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 three out of three infants in care, 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 Individual Infant Sleep Plan (LIC9227) for all infants in care under 12 months of age.

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: 5 of 5