444406269-9-22-2021-07-CC-EBEN-C752GS-20210922172338

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444406269
Report Date: 09/22/2021
Date Signed: 09/22/2021 05:24:09 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:	FERNANDEZ, MARIA		FACILITY NUMBER:	444406269
ADMINISTRATOR:	FERNANDEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 768-8470
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 9	DATE:	09/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Maria Fernandez		TIME COMPLETED:	10:45 AM

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) Elizabeth Berumen met with Licensee, Maria Fernandez for unannounced Required – 1 year annual inspection (KIT 2). LPA was granted access to the home by the Licensee. LPA also observed Licensee's spouse (Conrado Fernandez), adult son (Angel Fernandez) and adult daughter (Elizabeth Fernandez) and 9 day care children (1 infant & 7 preschool children and one school age) in the home during today's inspection. The Licensee was operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. The Licensee, her husband and two adult children live in the home. Licensee's daughter lives in a separate studio in the backyard. Licensee's 7 year old granddaughter lives in the home. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on September 7, 2021. The Licensee and assistants (Elizabeth and Angel Fernandez) have required vaccinations (MMR, Tdap). Licensee states that she and assistants annually obtain their flu shot. Licensee and assistants are current with the Mandated Reporter Training for Child Care Workers. Licensee's certificate is valid and expires 06/29/23, Elizabeth Fernandez certificate expires 09/14/22 and Angel's expires on 06/19/22. The Licensee CPR and First Aid certifications (expires 12/05/22). Assistants also have current CPR & First Aid certifications. Safe sleep update: LPA discussed the new “Safe Sleep” regulations with the Licensee and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensee. LPA reminded the Licensee that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects. LPA reviewed one infant file and observed that the Individual Sleeping Plan (LIC 9227) was in file. Licensee also has sleeping log in file for infant. LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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, MARIA	FACILITY NUMBER: 444406269
	VISIT DATE: 09/22/2021

NARRATIVE

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LPA observed a barricaded wall heater located in off limit hallway. The electic fireplace in the living room is screened. Off limit areas in the home: three bedrooms and two bathrooms. Licensee uses the converted garage for day care area. There is bathroom and and exit. Licensee uses the dining/living room area as entrance/exit to her day care. The backyard is fenced. Licensee uses an enclosed area for day care children. Portion of the backyard is off limits/ there is a studio and storage shed in off limit areas.

LPA observed a fully charged 2A10BC fire extinguisher and working smoke/carbon monoxide detectors. The Licensee states that she has a pet dog that is kept in off limit area of the backyard. There are no weapons in the home. No bodies of water were observed. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Any poisons are locked and inaccessible to the day care children. The Licensee states that she does not administer any medication to the day care children at this time.

A review of staff records on September 21, 2021 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 also reminded the 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 without two fully qualified adults present. The Licensee states that does not transport any day care children. The Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

LPA conducted an exit interview with the Licensee prior to the conclusion of today's inspection and advised her that no deficiencies issued during today's inspection. A copy of this report and a notice of site visit will be emailed to m.fernandez30@yahoo.com.

LICENSEE AGREES TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS IN A VISIBLE AREA.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

LIC809 (FAS) - (06/04)

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