444406210-5-14-2019-07-CC-EBEN-BC6LGP-20190514084504

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444406210
Report Date: 05/02/2019
Date Signed: 05/14/2019 08:45:08 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:	ANDRADE, MARIA & JOSE LUIS		FACILITY NUMBER:	444406210
ADMINISTRATOR:	ANDRADE, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 761-0636
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 7	DATE:	05/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Maria & Jose Andrade		TIME COMPLETED:	12:50 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 Analysts (LPA) Elizabeth Berumen met with Licensees, Maria and Jose Andrade for an unannounced annual/random inspection. LPA observed 7 day care children; 2 infants and 5 preschoolers present during today's inspection. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. Licensee, Maria Andrade states there are four adults living in the home; herself, her husband and two adult sons. A review of the staff records on 05/02/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA inspected the indoor and outdoor areas of the home today. Off limit areas inside the home are: three bedrooms, hall closets and garage. Licensee states there is no firearms/weapons in the home. LPA observed a storage shed for toys in the backyard. LPA observed a small play house in the backyard and reminded her to have visual supervision of children when they are in the play house to ensure safety of children. Backyard is fenced and no bodies of water were observed. LPA observed a 3A40BC fire extinguisher. Smoke and carbon monoxide detectors were tested and proved to be working. Home is clean and orderly with heating and ventilation for safety and comfort. LPA observed sufficient materials, toys, and play equipment for the day-care children. Telephone number is current and working. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children are stored where they are inaccessible to children. Licensees were reminded that storage areas for poisons shall be locked. LPA reviewed facility roster and fire disaster drill log; last practiced and documented earthquake drill was 04/26/19. LPA reviewed both Maria and Jose's file. Maria has current CPR & First aid expiring on 03/09/21 and Jose's certification for CPR & First Aid expires on 07/01/19. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 05/02/2019):

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

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: ANDRADE, MARIA & JOSE LUIS	FACILITY NUMBER: 444406210
	VISIT DATE: 05/02/2019

NARRATIVE

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Maria and Jose Andreade completed the mandated reporter, AB1207 compliant training. Maria completed her training on 10/28/17 and Jose completed his on 12/18/17. Licensee's understand that the course is to be renewed every two years. Maria and Jose have immunization against pertussis, measles and influenza.

LPA reviewed the files of 7 day care children. Files contain the required forms. No child currently enrolled is being provided incidental medical services. The family child care home shall submit as required by the department a Plan for Providing Incidental Medical Services before she administers any Incidental Medical Services.

LPA discussed Lead Safety Information (AB 2370). Chapter 676, statues of 2018, requires all child care providers, upon enrolling or re-enrolling any child, to provide the parent or guardian with written information.

Safe Sleep was discussed: place infants on their backs when sleeping, use a firm sleep surface such as a mattress in a safety approved crib, keep soft bedding such as blankets, pillows, toys out baby's sleep area and ensure that pacifiers have nothing attached to them.
LPA discussed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, etc.

An exit Interview was conducted with Maria Andrade in Spanish. A copy of this report was provided to Maria Andrade at the conclusion of the inspection.

As a result of today's inspection, no deficiency was cited.

NOTICE OF SITE VISIT WAS ISSUED 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: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

LIC809 (FAS) - (06/04)

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