444407941-5-8-2019-07-CC-EBEN-BBYQYA-20190508123448

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444407941
Report Date: 05/01/2019
Date Signed: 05/08/2019 12:35:05 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:	MELGOZA, LOURDES		FACILITY NUMBER:	444407941
ADMINISTRATOR:	MELGOZA, LOURDES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 763-0799
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 5	DATE:	05/01/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:40 PM
MET WITH:	Lourdes Melgoza		TIME COMPLETED:	05:00 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, Lourdes Melgoza and explained the nature of today's inspection to her. Present during the inspection was Licensee's husband, Joaquin Melgoza and 5 day care children; 2 infants and 3 preschoolers. Days and hours of operation are Monday - Saturday from 6:00 AM to 6:00 PM. The adults that live in the home are Licensee, her spouse and adult son, Alejandro Melgoza. LPA inspected the on limit areas of the indoor and outdoor areas of the home. 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 did not observe any wall heaters inside the home. Lourdes identified the following as off limits: 3 bedrooms, hall closet, and laundry area. The outdoor play area is fenced. LPA observed a fire disaster drill log posted on the wall during today's visit, no drills are documented as of today. LPA reminded Licensee that each family child care home shall conduct fire drills and disaster drills at least once every six months. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home for review. Telephone number changed, new telephone number is (831) 563-5707 and (831) 840-7044. LPA observed a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and no bodies of water. There is an electric fire place in the living room which is screened. The Licensee states that she does not have any weapons. All detergents, cleaning compounds, medications, and other similar items are stored in the garage inaccessible to children. All poisons are to be stored inaccessible to children and shall be locked. LPA observed several locked cabinets in laundry room area for storage of such items.

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: MELGOZA, LOURDES	FACILITY NUMBER: 444407941
	VISIT DATE: 05/01/2019

NARRATIVE

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Licensee has current CPR and First Aid certifications with an expiration date of 03/3/2021. Licensee completed mandated reporter, AB1207 compliant on 05/3/19. Licensee understands the course it to be renewed every two years. Licensee's husband completed the course on 04/16/18. Licensee and her husband have immunization against pertussis and measles. Lourdes and her husband have signed form declining the influenza vaccine dated 04/10/18 and 04/09/18.

LPA reviewed children files. Licensee is providing parents with consent to use nebulizer (LIC 9166) and states no child is being administered inhaled medication. LPA explained to Lourdes that form is not required; only when parents give authorization to Licensee to administer medication.

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.

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.

Exit Interview was conducted in Spanish with Lourdes Melgoza. 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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