444406018-5-2-2023-07-CC-EBEN-CRFSGL-20230502135207

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444406018
Report Date: 04/27/2023
Date Signed: 05/02/2023 01:52:30 PM

Document Has Been Signed on 05/02/2023 01:52 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:	PARRA, ANA		FACILITY NUMBER:	444406018
ADMINISTRATOR:	PARRA, ANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 722-5165
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 0	DATE:	04/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Ana Parra		TIME COMPLETED:	12:45 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), Elizabeth Berumen conducted a Required - 1 Year Inspection. LPA met with Licensee, Ana Parra and explained the nature of today's inspection with her. No day care children were present. Per Licensee, the adults who live in the home are herself, her husband, Jose Fernandez and son, Victor Fernandez. No minor children live in the home. The day-care is open Monday thru Friday from 6:00 AM to 5:30 PM. There are no active waivers or exceptions for this facility. The day-care is a two storey home with three bedrooms and two bathrooms. LPA observed a current children's roster (LIC9040). Copy of children's roster was obtained during the inspection. The last Fire/disaster drill was conducted on 03/06/23. LPA observed a fully charged 3A40BC fire extinguisher, functioning smoke and carbon monoxide detectors. The stairs are barricaded. The fire place is screened. Licensee states that there are no weapons or firearms in the home. Incidental Medical Services (IMS) policy was discussed. Licensee states that she is not planning to administer any medication at this time. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Family Child Care Homes, Section 102417. When any IMS is provided, a Plan for Providing 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 LPA reminded licensee that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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. Continuation on next page:`

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

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: PARRA, ANA	FACILITY NUMBER: 444406018
	VISIT DATE: 04/27/2023

NARRATIVE

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Off limit areas in the home: entire upstairs (three bedrooms and bathroom). The backyard is fenced and safe for children. Storage shed in the backyard is locked and not used for day care. Cleaning products, sharp objects, and other items that are dangerous to children were stored inaccessible. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. The children's bathroom is clean, sanitary, and operable. The home has a working telephone which and provided her cell phone (831) 234-8370. No bodies of water were observed.

LPA reviewed 3 children’s files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), and Immunization Records (PM 286/CDPH 286).

Licensee's Mandated Reporter Training was completed on April 15, 2022. Licensee has immunization in Measles, Pertussis, and Influenza. Licensee and her helpers have current Pediatric CPR/First Aid certifications. Licensee's CPR & First Aid expires on 01/24/24.

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

Exit interview conducted and report was reviewed with Licensee, Ana Parra.

As a result of today's inspection, there were no deficiencies cited.

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

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC809 (FAS) - (06/04)

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