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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406696
Report Date: 01/12/2022
Date Signed: 01/12/2022 04:46:45 PM

Document Has Been Signed on 01/12/2022 04:46 PM - It Cannot Be Edited

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:HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOLFACILITY NUMBER:
444406696
ADMINISTRATOR:REGINA MOLINAFACILITY TYPE:
850
ADDRESS:40 BLANCA LANETELEPHONE:
(831) 724-0175
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: 47DATE:
01/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:42 PM
MET WITH:Regina MolinaTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Cortney Nelson and Samantha Yip, became aware of COVID positive cases at Hearts and Hands Christian Childcare and Preschool that were not reported to Licensing.

COVID positive case was confirmed by Department of Public Health, which was not reported to licensing based on record review.

A deficiency has been cited, refer to 809-D for citation, description, and plan of correction.

Exit interview conducted and report was reviewed with the licensee, Regina Molina.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2022
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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Document Has Been Signed on 01/12/2022 04:46 PM - It Cannot Be Edited


Created By: Cortney Nelson On 01/12/2022 at 03:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOL
FACILITY NUMBER: 444406696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/26/2022
Section Cited
CCR
101212(d)(1)(E)

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(d) Upon the occurrence... a report shall be made to the Department by telephone or fax within the Departments next working day and during its normal business hours. In addition, a written report...shall be submitted to the Department within seven days following the occurrence...(1) Events reported shall include...(E) Epidemic Outbreaks.

This requirement is not met as evidenced by:
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Licensee will read through California Code of Regulations Section 101212- Reporting Requirements. Once Licensee has read through requirements, she will submit a signed document, indicating her understanding of reporting requirements for Child Care Centers to the Department by 1/26/2022.
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Based on record review and interviews, the Licensee did not report cases of epidemic outbreak at the facility to the Department. This poses a potential risk to the health, safety, and personal rights of the children in care.
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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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2022


LIC809 (FAS) - (06/04)
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