444406079-8-2-2019-07-CC-MBED-BENN8T-20190802101451

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444406079
Report Date: 07/24/2019
Date Signed: 08/02/2019 10:14:55 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:	FELIX SANDOVAL, MARIA & RAMIRO & ORTIZ HARO, MARIA		FACILITY NUMBER:	444406079
ADMINISTRATOR:	FELIX, MARIA & ORTIZ, LUPE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 763-1467
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 0	DATE:	07/24/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Maria Felix		TIME COMPLETED:	10:35 AM

NARRATIVE

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Licensing Program Analyst (LPA) Mahvash Behbood conducted an unannounced Annual Random visit. The purpose of today’s visit explained to licensee. Maria has stopped operating for over a year and now she is planning to resume her operation working with migrant program. During operation her hours would be Monday - Friday, from 6 AM to 6 PM. Maria and her husband, her adult son and her 3 other children ages, 14, 16, and 17 live in the facility. All adults or other individuals who require caregiver background checks have received criminal record and child abuse index clearance or exemptions. Maria stated Maria Ortiz Haro, her co-licensee no longer live here and no longer is interested to remain on the license. Maria is to submit LIC 279 to remove Maria Ortiz Haro from the license. Licensee's CPR and First Aid are current and expire in 05/2020. Maria and Ramiro/assistance all have copies of the required immunization as well as California Mandated Reporter Training. Licensee is aware that the Mandated Training must be completed every 2 years.

LPA toured indoor and outdoor areas of the home during today's visit. Phone listed is a land line and operational. LPA observed sufficient materials, toys, and play equipment for day care children. The home is clean, orderly, and safe for the day care children. 3 bedrooms are off limit inside the home. Children play in the fenced side yard, the back yard is off limit. The detached garage located in the back yard is converted to game room for her children and is off limit to children.

LPA observed a fully charged fire extinguisher, working smoke/carbon monoxide detectors, and no bodies of water observed. Licensee states she does not have any weapons in the home. All detergents, cleaning compounds, poisons, medications, are out of reach and inaccessible to children.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash Behbood	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019

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: FELIX SANDOVAL, MARIA & RAMIRO & ORTIZ HARO, MARIA	FACILITY NUMBER: 444406079
	VISIT DATE: 07/24/2019

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Discussed with Maria was her responsibility to respond to phone calls from her analyst and communicate with the Department regarding her operation plans. In the past year numerous messages has been left for her to inquire about her operation, all call has been disregarded.

Effect of lead exposure poster was provided to licensee and for their information and to share with children. Discussed also was safe sleep.

No citation issued during today's visiy.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash Behbood	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019

LIC809 (FAS) - (06/04)

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