444406235-11-20-2019-07-CC-FCJO-BJ4UPY-20191120144619

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444406235
Report Date: 11/20/2019
Date Signed: 11/20/2019 02:46:27 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:	MONTESINOS, RAQUEL		FACILITY NUMBER:	444406235
ADMINISTRATOR:	MONTESINOS & GARCIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 728-5036
CITY:	FREEDOM	STATE: CA	ZIP CODE:	95019
CAPACITY:	14	CENSUS: 5	DATE:	11/20/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Raquel Montesinos		TIME COMPLETED:	03:00 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 Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual random inspection to the home today. LPA met with Raquel Montesinos, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM. The adults that reside in the home are the Licensee, her spouse Ramiro, and her adult children Askary and Renata. Present in today's inspection were five children in care included one infant and four preschoolers. Present also in the home was Licensee's helper Maria. Licensee's certification for CPR and First Aid are current and will expire on 3/10/2020 for herself and for her helper Maria as well. LPA toured the indoor areas of the home during today's inspection. LPA obtained a copy of the Child Care Facility Roster during today's inspection and it is current. LPA reviewed the Fire/Disaster drill log during today's visit. Last fire drill was documented on 11/06/19. LPA reviewed 5 children's files and are complete including a Parent's Rights form and the immunization records form. Licensee has a working telephone (landline) in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. LPA observed the home has central A/C and heating. Off limit areas in the home are the living room, three bedrooms, and two bathrooms. The home washing and dryer are located in a separate area by the garage. There are no stairs in the home. Off limits area outside is the right portion of the back yard. The home has a playground area located in the back yard. LPA observed a fully charged 3A40BC fire extinguisher last serviced on March 2019. LPA observed the home has a working smoke detector and no bodies of water. LPA observed the home does not have a working Carbon Monoxide detector. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. LPA discussed IMS with the Licensee. Licensee has in file immunization records for pertussis, measles, and flu vaccines for herself and for her helper according with the SB792. A review of staff records on 11/18/19 indicates that all adults residing in the home or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. *******************************Report dated 11/20/2019 continues in page 2.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

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: MONTESINOS, RAQUEL	FACILITY NUMBER: 444406235
	VISIT DATE: 11/20/2019

NARRATIVE

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Report dated 11/20/2019 continues from page 1.

LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
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. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time, the ratio (age of the children) must be observed and a qualified assistant must be present. The Licensee states that she does not transport children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.

Department website: www.ccld.ca.gov provided to Licensee.
LPA discussed the requirements of AB 633 with the Licensee. LPA also discussed "zero tolerance" related regulations with the Licensee.
Licensee was advised to renew the "Mandated Reporter" training that all Licensees and adults in contact with children are required to take in accordance with the AB1207, Licensee' training certificate has expired on 10/29/19. Licensee stated she feels more comfortable taking the training in Spanish. Licensee understands that all the adults in contact with children are required to take the training as soon as it is available in Spanish. Licensee's helper Maria has taken the training on 3/13/2018.
LPA advised licensee of the pending Department regulation update re: Safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information. LPA provided licensee with a Child Care Advocate email: rwillia1@dss.ca.gov
A type B deficiency was cited. Licensee's rights was printed and given to Licensee. Exit interview and inspection was conducted with licensee in Spanish. Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.
A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

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: MONTESINOS, RAQUEL	FACILITY NUMBER: 444406235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/20/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/04/2019 Section Cited	1 2 3 4 5 6 7	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 of Division 12. The department shall account for the presence of these detectors during inspections.
	8 9 10 11 12 13 14	This regulation was not met as evidenced by: Licensee's home does not have installed a working CO detector.Licensee understands this poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

LIC809 (FAS) - (06/04)

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