444406227-5-29-2019-07-CC-EBEN-BCMM3P-20190529091526

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444406227
Report Date: 05/23/2019
Date Signed: 05/29/2019 09:15:34 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:	FERNANDEZ, ROSALIA		FACILITY NUMBER:	444406227
ADMINISTRATOR:	FERNANDEZ, ROSALIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 763-2095
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS:	DATE:	05/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Rosalie Fernandez		TIME COMPLETED:	01:30 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 conducted an unannounced random inspection to the home today. LPA met with Licensee, Rosalia Fernandez and explained the nature of today's inspection to her. LPA observed 10 day care children and adult helper, Karina Lopez Ortiz present during. Three of the 10 children are infants and 7 are preschoolers. Rosalia states her and her niece, Alma Fernandez are the only adults living in the home. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. Rosalia has current CPR & First Aid expiring on 01/19/21. LPA inspected the indoor and outdoor areas of the home during today's visit. Off limit areas inside the home are: two bedrooms, and attached garage. Off limit areas outside the home are detached shed in the backyard and right side of the backyard. The backyard is fenced. LPA reviewed and obtained a copy of the Child Care Facility Roster. LPA reviewed fire disaster drill log; last practiced drill was 05/13/19. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. LPA observed a covered fire place, located in the living room. LPA observed a fully charged 3A40BC fire extinguisher, working smoke detector, carbon monoxide detector. No bodies of water were observed. Rosalia states, there are no weapons in the home. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children are stored inaccessible to children. LPA reviewed Licensee's and Assistant (Karia Lopez Ortiz) immunization's against pertussis, measles and influenza. Licensee, Rosalia Fernandez and assistant, Karina Lopez Ortiz completed the Mandated Reporter Training. They understand that Training is to be renewed every two years.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019

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: FERNANDEZ, ROSALIA	FACILITY NUMBER: 444406227
	VISIT DATE: 05/23/2019

NARRATIVE

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Supervision of children was discussed with Rosalia Fernandez. Licensee does not provide transportation services to children; however, she understands that children cannot be left in parked vehicles unattended at any time.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage are for medication and equipment/supplies, during today's inspection. LPA notes that no child currently enrolled is being provided 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. LPA provided Licensee with website www.ccld.ca.gov so she can access and print out the 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 provided a flyer to Licensee during today's inspection.

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 in Spanish. A copy of this report was provided to Licensee's Rosalia Fernandez at the conclusion of the inspection.

No Deficiency cited.
NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS. No

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019

LIC809 (FAS) - (06/04)

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