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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444407896
Report Date: 05/13/2019
Date Signed: 05/13/2019 11:14:12 AM

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:ESCOBAR, LUZ MARIAFACILITY NUMBER:
444407896
ADMINISTRATOR:ESCOBAR, LUZ MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-9033
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 12DATE:
05/13/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Luz Maria EscobarTIME COMPLETED:
11:00 AM
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 Licensing Program Analyst (LPA) Elizabeth Berumen conducted an annual random inspection. LPA met with Licensee, Luz Maria Escobar and explained the nature of today's visit to her. LPA also observed Licensee's spouse, Esteban Fernandez and 12 day care children (2 infants, 10 pre-schoolers).

Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. Luz states there are four adults living in the home; herself, her husband and two adult daughters, Daisy and Gabriela. Luz has three younger children who also live in the home ages; 17, 15, and 9 years old. Luz Maria's 17 year old will be 18 in December 29,2019 and understands requirements; including fingerprint clearances. A review of staff records on May 8, 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 Luz Maria Escobar 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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

LPA inspected the indoor and outdoor areas of the home. Off limit areas in the home are 4 bedrooms, kitchen, garage and 1 bathroom. Off limits on the outside of the home are the left and right side yards. The storage shed in the backyard is off limits. The trampoline in the off limit backyard area is not used for day care children.

LPA reviewed and obtained a copy of facility roster. Licensee did not have a fire disaster drill log available for review; she states she re-opened her day care May 9, 2019 and has not practiced a drill. Licensee works from May to November with the migrant program. LPA advised her to keep copies of fire disaster drill logs before turning them in to the Migrant Program. 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. LPA observed a barricaded fire place.

(report dated 05/13/2019 continues on 809 C)
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
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: ESCOBAR, LUZ MARIA
FACILITY NUMBER: 444407896
VISIT DATE: 05/13/2019
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The home is equipped with a 2A10BC fire extinguisher. The carbon monoxide and smoke detectors were tested and proved to be functioning. The Licensee states that there are no weapons in the home. Luz Maria has a pet dog. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. All poisons are to be stored inaccessible to children and shall be locked.

LPA reviewed children files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file.

LPA reviewed Licensee's Maria Luz Escobar's file - Maria Luz completed the Mandated Reporter Training on 10/29/2017. Maria Luz has current CPR & First Aid Certification, expiring on 04/11/21. Maria Luz has immunization against pertussis and measles.
LPA reviewed licensee's assistant/husband Esteban Fernandez' file - he completed the mandated reporter training on 03/21/18. Esteban Fernandez has current CPR & First Aid expiring on, 04/11/21. Esteban has immunization against pertussis and measles.
Licensee and her assistant/husband signed a declination statement stating they do not get the influenza vaccine during today's inspection.

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. website www.ccld.ca.gov was provided; Licensee can access the Effects of Lead exposure flyer to handout to parents.

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.

An exit interview was conducted with Licensee in Spanish. No deficiency cited. A copy of this report was provided to Luz Maria Escobar at the conclusion of the inspection.
NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
LIC809 (FAS) - (06/04)
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