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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444407366
Report Date: 08/09/2019
Date Signed: 08/09/2019 02:27:32 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:CERVANTES, ROSIEFACILITY NUMBER:
444407366
ADMINISTRATOR:CERVANTES, ROSIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 728-7263
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 6DATE:
08/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:52 PM
MET WITH:Rosie CervantesTIME COMPLETED:
02:40 PM
NARRATIVE
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LPA Behbood met with licensee to conduct an annual visit. There were 6 children in care, including her 11 month old daughter and 3 year old son. Living in the home are licensee, her husband, her mother/helper and her 3 children ages, 11 month, 3 and 15 year old. All adults or other individuals who require caregiver background checks have received criminal record and child abuse index clearance or exemptions. Days and hours of operation are Monday through-Friday, 7:30 AM to 5:30 PM.
LPA toured both the inside and outside of the home. There is a hot tub that is covered but the lock on the cover is broken. Licensee states that there are no firearms/weapons in the home. Medicines, poisons and cleaning supplies are inaccessible to the children. There is a fully charged fire extinguisher, operational smoke and carbon monoxide detector. Home appears clean, has proper heating, lighting and ventilation for safety and comfort. LPA observed safe and sufficient toys, play equipment, materials and supplies for the day-care. Telephone is in working order. Licensee understands smoking is prohibited. Entire second floor, and two bedrooms downstairs are off limit. Day care is conducted in the added sun room turned into day care. Children nap in the living room. Outdoor Off Limit Area are 2 detached bedrooms , the entire right hand side of the yard below the steps where the hot tub is located and the shed.
Licensee has current CPR and First Aid that expires on 03/15/2021. She has an up to date children's roster. The fire drills are documented. Children were supervised during the visit. Provider and her mom both have proof of immunization. Licensee and her mom also completed Mandated Child Abuse Reporter Training.
Licensee states she doesn't transport children and understands children may never be left in a parked vehicles. She understands car seat law.
Please see next page for citation under Title 22.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CERVANTES, ROSIE
FACILITY NUMBER: 444407366
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/16/2019
Section Cited
CCR
102417(6)(5)
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Operation of Family Child Care Home- All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence. The hot Tub cover's lock is broken and the hot tub had water. Though the cover is heavy enough for children to be able to lift but this is a potential risk to health and safety of children,
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Licensee will consult with her husband to either remove the hot tub or replace the cover. This must be done no later than 08/16/19.
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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019
LIC809 (FAS) - (06/04)
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