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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406126
Report Date: 10/16/2019
Date Signed: 10/16/2019 01:13:13 PM

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:JACINTO, RAMONA & FRANKFACILITY NUMBER:
444406126
ADMINISTRATOR:JACINTO, RAMONAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-8017
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 10DATE:
10/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Ramona JacintoTIME COMPLETED:
01:15 PM
NARRATIVE
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An unannounced random visit made by Analyst Mahvash Behbood. Kit #2 was used for this inspection. Present were Ramona & Frank , licensees, their helper/son and 10 day care children. Living in this facility are: Ramona and Frank. All adults living at home and working at the facility are finger printed and cleared. Ramona understands that all adults that live in the home or help with the children must have a clearance before they can be present. Failure to do so will result in a fine. Hours of operation is Monday through Friday from 6 to 6 PM. Inside and outside of the facility was toured. Off limit area inside the home: 3 bedrooms, and garage. Off limit area outside the home: All the storage shed and the side yards.
The licensee is not providing IMS (Incidental Medical Services) at this time.
Ramona states there are no weapons in the home.
Cleaning supplies, medicines & similar items stored inaccessible to children
There is a Fireplace properly barricaded, there are no wall heater or stair case.
There is a fully charged correct size fire extinguisher, working smoke alarm and carbon monoxide detector. Licensee has working land line/ telephone.
Children were supervised during the visit. Discussed with Ramona regarding supervision of children and she understand her ratio.
Children play in the backyard which is fenced. There are plenty of age appropriate toys and play equipment.
Ramona has a current children roster.
Ramona's CPR expires on 02/03/2020. Licensee and her helpers all up to date with their immunization. Licensee transport school age children.
Please see next page for citations under Title 22.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
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 3
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: JACINTO, RAMONA & FRANK
FACILITY NUMBER: 444406126
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/23/2019
Section Cited

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Health and Safety - Mandated Child Abuse Reporter Training. Licensees and their helper/son have not completed the Mandated Child Abuse Reporter Training. This is potentially dangerous to health and safety of children.

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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: JACINTO, RAMONA & FRANK
FACILITY NUMBER: 444406126
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/16/2019
Section Cited

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Personal Rights- Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative.
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Upon arrival it was observed 3 children in high chair and 2 in play pen. Food was not serving and children in playpen were not napping. Per licensee they were there becasue they were putting up holiday decoration. Putting children in high chair and playpen to limit their movement is an immediate harm to their health and safety.
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This must be sent to analyst no later than 10/23/19.
Due to the fact that the citations are "A" violations the Parent Notification Requirements must be followed, and the parent or authorized representative of each child in care must be given a copy of today's report and a signed LIC 9224 must be kept in their child's file. For the next 12 months, the parent of authorized representative of any newly enrolled child must also be given a copy of today's report, and a signed LIC 9224 must be kept in their child's file as well.

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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3