444407252-8-8-2019-07-CC-EBEN-BEUTCA-20190808143626

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444407252
Report Date: 08/06/2019
Date Signed: 08/08/2019 02:36:44 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:	LOBATO, MARIA		FACILITY NUMBER:	444407252
ADMINISTRATOR:	MARIA LOBATO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 768-1881
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 13	DATE:	08/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Maria Lobato		TIME COMPLETED:	03:30 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) Elizabeth Berumen conducted an annual random inspection. LPA met with Licensee, Maria Lobato and explained the nature of today's inspection to her. Also present during inspection was Licensee's daughter/Assistant (Maria Villanueva), adult son, Victor Villanueva, Precilla Goana, 10 day care children and 3 grandchildren (3 infants, 8 preschoolers and 2 school age). Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. The adults that live in the home are: Licensee, spouse, two sons and daughter in law. Licensee has a 16 year old son and 4 year old granddaughter who live in the home. A review of staff records on July 31, 2019 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 Marisol 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. LPA reviewed and obtained a copy of Child Care Facility Roster during the inspection. A Fire/Disaster drill log was reviewed. The last fire/disaster drill was competed on 07/16/19. LPA inspected parts of the facility in which family day care services are being provided and areas which children have access. Off limit areas in the home are: 3 bedroom/1 bathroom, 3 hallway closets, attached garage with laundry room and detached garage/storage. The wood burning stove in the living room is not to be used during child care hours nor shall it ever be hot to the touch when children are present. A waiver for wood burning stove was granted on November 10, 2005. Licensee understands the conditions of the waiver, failure to comply with the conditions of the waiver may result in termination of the waiver. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean and orderly. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 008/06/2019):

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019

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: LOBATO, MARIA	FACILITY NUMBER: 444407252
	VISIT DATE: 08/06/2019

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 08/06/2019):
LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. Maria Lobtato states that there are no weapons in the home. Detergents, cleaning compounds, medications, and other similar items are inaccessible to children.

LPA reviewed Licensee and Maria Villanueva's file; Both have proof of immunization's for Measles (MMR), and pertussis (Tdap). Licensee, Maria Lobato completed the Mandated Reporter Training on 03/13/18. Maria Villanueva (daughter/assistant) completed the Mandated Reporter Training on 03/11/18. The Licensee's certifications for CPR and First Aid are current and expire on 02/23/21.

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel and administrative records.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

LPA discussed Lead Safety Information (AB 2370). Chapter 676, statues of 2018, requires all child care providers, upon enrolling or re-enrolling any child, to provide the parent or guardian with written information.

No deficiencies cited.

NOTICE OF SITE VISIT WAS ISSUED AND SHALL REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019

LIC809 (FAS) - (06/04)

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