444408165-9-17-2019-07-CC-EBEN-BG4T2E-20190917142035

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444408165
Report Date: 09/13/2019
Date Signed: 09/17/2019 02:21:04 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, GUADALUPE		FACILITY NUMBER:	444408165
ADMINISTRATOR:	GUADALUPE LOBATO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 724-8929
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 8	DATE:	09/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Guadalupe Lobato		TIME COMPLETED:	11:15 AM

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 met with Licensee, Guadalupe Lobato for an unannounced annual random inspection. LPA observed Licensee's Assistant, Sadi Lobato and 8 day care children (all preschoolers) in the home during today's inspection. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. Guadalupe states there are 9 adults living in the home and Licensee's two daughters; ages 11 and 8. A review of staff records on 09/10/19 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 Licensee 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 Guadalupe and Sadi's file. Guadalupe's certifications for CPR and First Aid are current and expire on 04/2020. Guadalupe and Sadi both have immunization against pertussis and measles. Guadalupe and Sadi completed the mandated reporter training AB1207 complaint on 03/26/18. Sadi declines the influenza vaccine. LPA reviewed the Child Care Facility Roster and obtained a copy. The Fire/Disaster drill log was reviewed during today's inspection; The last fire/disaster drill was completed on 08/06/19 Last practiced earthquake drill was on 08/13/19. LPA inspected the on limit indoor and outdoor areas of the home during today's inspection. Off limit areas in the home are two bedrooms and kitchen. Off limit areas outside the home are sheds, studio (were son sleeps) and left side yard. The Licensee has a working telephone in the home; Guadulupe provided her cell number (831)406-8823. 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. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 09/13/2019):

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019

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: LOBATO, GUADALUPE	FACILITY NUMBER: 444408165
	VISIT DATE: 09/13/2019

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
26
27
28
29
30
31
32

LPA observed a fire extinguisher. The smoke/carbon monoxide detector were tested and proved to be functioning. The backyard is fenced and no bodies of water were observed. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. Guadalupe has a locked shed were she stores toxins, poisons and similar items.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time; when more than 8 children an assistant is required.

The Licensee states that she does not transport children however she understands that children cannot be left unattended in a vehicle.

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the Licensee.

No deficiencies issued during today's inspection.
LPA conducted an exit interview with the Licensee prior to the conclusion of today's inspection

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2