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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444407248
Report Date: 06/20/2019
Date Signed: 06/20/2019 01:01:03 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, YOLANDAFACILITY NUMBER:
444407248
ADMINISTRATOR:YOLANDA FERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-4271
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 13DATE:
06/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Yolanda FernandezTIME COMPLETED:
01:15 PM
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Unannounced random visit made by Mahvash Behbood. Met licensee Yolanda Fernandez, purpose of the visit explained. Present also were her helper, her adult daughter and 13 day care children, including 2 infants, 1 school age and the rest between 2 and 5 years old Days and hours of operation is M through F from 6 AM to 6 PM. Inside and outside of the home inspected. Children and staff file reviewed. Staff file contain certificate of completing Mandated Reporter Training and their Immunization records. Children's file contained their emergency information, and immunization.
There are no bodies of water on the property. Licensee stated there are no gun at home.
Cleaning supplies stored inaccessible to children. There is a waiver for an electric fire place located in the living room Fire extinguisher is the correct size. Smoke and carbon monoxide are operational. Toys and play equipment are safe and age appropriate.
Telephone is working and the phone number is still the same.
Children were supervised during the visit.
Backyard where children play is fenced.
Licensee's roster was up to date.
The fire/disaster drill log is updated The last fire drill was in May of 2019.
Living at home are: Licensee, her husband, her two adult daughters and one 13 year old daughter. All adult living in the home and her helper have criminal record clearances.
CPR and First Aid for licensee and her helper expires on 02/20/2921. Licensee is not providing IMS.
Off limits: Garage, entire second floor
Stairs leading to second floor is gated.
Lead poisoning poster provided to share with parents. Safe sleep was also discussed.
Licensee is Spanish Speaker and her daughter translated this report for her.
No deficiency noted during today's visit
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
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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