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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406224
Report Date: 07/12/2019
Date Signed: 07/12/2019 12:29:33 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:ALVAREZ, MARIAFACILITY NUMBER:
444406224
ADMINISTRATOR:ALVAREZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 724-5641
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: DATE:
07/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria AlvarezTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Elizabeth Berumen, conducted an unannounced annual random inspection. LPA met with Licensee, Maria Alvarez, and explained the nature of today's visit. No day care children were present. Licensee states she will begin care on Monday July 15, 2019.

Maria Alvarez states that her hours of operation are Monday to Friday from 6:00 AM to 6:00 PM. Maria states that herself, her husband and adult daughter, Gabriela Alvarez live in the home. A review of staff records during today's visit 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. Off limit areas in the home are three bedrooms, and garage (living room). LPA notes that garage is set up as a living room and has a bathroom. Off limit areas outside: storage shed and fenced off area around the storage shed. Maria uses the outside area closest to her sliding door for children. LPA observed two barricaded wall heaters, 2A10BC fire extinguisher, working smoke and carbon monoxide detectors. Licensee states there are no weapons in the home. Cleaning supplies, sharp objects, medications are stored inaccessible to children.

LPA reviewed roster and obtained a copy. LPA reviewed fire disaster drill log; last practiced drill documented was 12/11/18. LPA reminded her to practice fire disaster drills once every 6 months, she states she hasn't cared for children for the past 7 months and will start July 15, 2019. LPA reviewed immunization records for Maria Alvarez she has immunization against pertussis and measles. Maria Alvarez declined the influenza vaccine due to her recent knee surgery. Maria Alvarez has current CPR & First Aid expiring on 01/19/2021. Mandated Reporter Training was completed by Maria Alvarez on 08/15/17. LPA reminded Maria that the Mandated Reporter Training is to be completed once every two years.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
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 2
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: ALVAREZ, MARIA
FACILITY NUMBER: 444406224
VISIT DATE: 07/12/2019
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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. LPA provided Licensee with, Effects of Lead exposure flyer to handout to parents.

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 emailed Licensee link to access information.

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.


Exit Interview was conducted. A copy of this report was provided to the Licensee at the conclusion of the inspection.

No deficiency cited.

NOTICE OF SITE VISIT WAS ISSUED 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: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2