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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444407145
Report Date: 08/28/2019
Date Signed: 08/28/2019 12:48:09 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:AGUIRRE, IRENEFACILITY NUMBER:
444407145
ADMINISTRATOR:AGUIRRE, IRENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 421-0321
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY:14CENSUS: 12DATE:
08/28/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Irene AguirreTIME COMPLETED:
12:45 PM
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On August 28, 2019 Licensing Program Analysts (LPA's) Nancy Rodriguez and Zaid Hakim conducted an Unannounced Case - Management - Other Inspection at the facility. The purpose of the inspection is the Licensee, Irene Aguirre, has requested to add 2 additional bedrooms to her On Limit Day Care Use areas. The Licensee has received an updated Fire Clearance from the local fire authority dated 08/14/19. At the time of the inspection of the physical plant there were 12 preschool children present supervised by 3 staff members. The physical plant was found to be neat and orderly and with age appropriate toys and equipment in good condition. LPA observed 12 sleep mats available each individually labeled. The perimeter is enclosed by a fence and gates have lock and key attached. Staff and children were observed to be fully engaged during whole time of visit.

The two bedrooms Licensee is adding were inspected and found safe and orderly. Licensee intends to use 1 bedroom as a sleeping space for infants and the other bedroom as a backup infant sleeping area. LPAs reminded licensee of current Safe Sleep Guidelines and pending Safe Sleep regulations regarding safe sleep for infants in care.

LPA Rodriguez reviewed a random sample of children's records and all were found to be complete and up to date. LPA Rodriguez reviewed three staff files and files were found to be complete and up to date including current Mandated Reported training. LPA observed a current children's roster. The last fire drill was conducted on 04/05/19. As of today's date, Community Care Licensing has received an updated Fire Clearance from the local fire authority and an updated LIC 999 Facility Sketch from the Licensee. On Limit Day Care Use areas now include: 2 bedrooms, the living room, the outdoor unit (classroom), the backyard area (outdoor play area), and 2 restrooms.

LPAs and the Licensee discussed health effects of lead and safe sleep best practices for infants.

LPA advised that licensing forms and all other information can be found at: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing

A Notice Site Visit has been issued and must remain posted for 30 consecutive days.

No Deficiencies have been cited as a result of today's inspection.

Exit interview conducted with Ms. Irene Aguirre, Licensee.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Nancy RodriguezTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
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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