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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406079
Report Date: 08/26/2022
Date Signed: 08/30/2022 01:59:44 PM


Document Has Been Signed on 08/30/2022 01:59 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:SANDOVAL, MARIA & FELIX, RAMIROFACILITY NUMBER:
444406079
ADMINISTRATOR:SANDOVAL, MARIA & FELIX, RFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 763-1467
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 0DATE:
08/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Maria SandovalTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Maria Sandoval for an unannounced Required – 1 year annual inspection. LPA was granted access to the home by the Licensee. No day care children present in the home. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. The adults residing in the home are: Licensee, her spouse (Ramiro Felix), adults sons (Samuel, Ramiro Jr. One 17 year old daughter. Licensee states that she has and adult daughter (Pricilla Sandoval Felix) and son (Justin Sandoval Felix) who are in college. Licensee requests to remove her husband, Ramiro Sandoval from the license. LPA obtained an updated LIC 279 and a statement signed by Ramiro requesting to be removed from License.

LPA provided licensee with a child facility roster. LPA reminded Licensee to practice and document fire disaster drills. Licensee has day care insurance.
Licensee has current CPR and First Aid certifications (expiration: 08/13/2024). Licensee has the required vaccines (MMR, Tdap) and declines the influenza vaccine. Licensee is current with her Mandated Report Training for Child Care Workers (expiration: 08/15/2024).

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home and provided LPA with cell number (831) 707-4057. The home is clean, orderly, (including heating/ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. There are no stairs or wall heater units inside the home. Off limit areas in the home: kitchen, 3 bedrooms (one bathroom in master bedroom). Licensee uses the left side patio for day care children. There is a fenced off portion that is off limits to children (backyard). Detached garage is off limits. No bodies of water were observed. Backyard is fenced.

LPA observed a fully charged 3A40BC fire extinguisher. The smoke detector was tested and proved to be functioning. The Licensee states that she does not have any pets or weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Licensee states that there are no poisons in the home. Licensee provides breakfast, snacks, lunch to children. Licensee states that all food brought from home is labeled with each child's name and properly stored. Licensee states that no one smokes and she understands that smoking is prohibited in the home.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2022
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: SANDOVAL, MARIA & FELIX, RAMIRO
FACILITY NUMBER: 444406079
VISIT DATE: 08/26/2022
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Incidental Medical Services (IMS) policy was discussed. 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 (USDOJ) 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

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity/ratio options and she understands that she cannot have more than 14 children present in the home without at least two qualified adults present. Licensee states that a child will be isolated in the living room area if necessary due to illness or communicable disease. Licensee states that does not transport any day care children. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Licensee was reminded 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. Licensee's daughter Pricilla Sandoval Felix criminal record clearances are pending.

LPA discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Licensee 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.

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 the Licensee, Maria Sandoval. Deficiency issued during today's inspection on 809 D page.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 08/30/2022 01:59 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: SANDOVAL, MARIA & FELIX, RAMIRO
FACILITY NUMBER: 444406079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/02/2022
Plan of Correction
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Licensee agrees to purchase and install a smoke detector and send proof of purchase to LPA Berumen by plan of correction date of 09/02/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2022
LIC809 (FAS) - (06/04)
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