444407692-5-1-2019-07-CC-EBEN-BBRUBB-20190501152605

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444407692
Report Date: 05/01/2019
Date Signed: 05/01/2019 03:26:11 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:	NOLASCO, LETICIA		FACILITY NUMBER:	444407692
ADMINISTRATOR:	NOLASCO, LETICIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 724-6026
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 5	DATE:	05/01/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Teresa Nolasco		TIME COMPLETED:	03:10 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 Analysts (LPA), Elizabeth Berumen conducted an annual random inspection. LPA met with Licensee's Mother Teresa Nolasco and explained the nature of today's inspection. Also present in the home were 5 day care children, all preschoolers. Teresa Nolasco states that Licensee, Leticia Nolasco stepped out to run an errand. Teresa Nolasco has criminal record clearances. There are three adults living in the home; Licensee, her boyfriend, David Rocha and Teresa Nolasco. A review of staff records on April 30, 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. Licensee, Leticia arrived shortly after LPA's arrival. LPA inspected the indoor and outdoor areas of the home. Off limit areas are entire upstairs and garage. LPA observed barricaded stairs and covered fire place. LPA reviewed a current Child Care Facility Roster and fire disaster drill. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. Licensee states there is a new telephone number in the home; (831) 722-2484. LPA reviewed roster and fire/disaster drill log. LPA observed a fully charged 2A10BC fire extinguisher. The dual smoke and carbon monoxide detector was tested and proved to be functioning. The backyard is fenced, clean and safe for the children. No bodies of water were observed. Teresa states that there are no weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019

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: NOLASCO, LETICIA	FACILITY NUMBER: 444407692
	VISIT DATE: 05/01/2019

NARRATIVE

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Licensee has current CPR and First Aid certifications with an expiration date of 11/2019. Licensee completed mandated reporter, AB1207 compliant on 11/06/17. Licensee understands the course it to be renewed every two years. Licensee has immunization against pertussis, measles. Licensee declined the influenza vaccine and has signed written statement. LPA reviewed the file for Teresa Nolasco Assistant present today, Teresa Nolasco has current CPR & First Aid, expiring 06/2020. Teresa Nolasco has immunization against pertussis and measles.

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 guarding. LPA provided website www.ccld.ca.gov.

Safe Sleep was discussed: place infants on their backs when sleeping, use a firm sleep surface such as a mattress in a safety approved crib, keep soft bedding such as blankets, pillows, toys out baby's sleep area and ensure that pacifiers have nothing attached to them.
LPA discussed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, etc.

LPA updated an Application for family child care (LIC 279) home during inspection to update phone number and adults living in the home. LPA obtained a copy of David Rocha's tb test and criminal record statement (LIC508).

Exit Interview was conducted with Licensee. A copy of this report was provided to the Licensee at the conclusion of the inspection. No deficiency cited.
NOTICE OF SITE VISIT WAS ISSUED AND MUST 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: 05/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019

LIC809 (FAS) - (06/04)

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