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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444408165
Report Date: 12/22/2022
Date Signed: 12/23/2022 11:21:19 AM


Document Has Been Signed on 12/23/2022 11:21 AM - It Cannot Be Edited

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, GUADALUPEFACILITY NUMBER:
444408165
ADMINISTRATOR:GUADALUPE LOBATOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 724-8929
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 2DATE:
12/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Guadalupe Lobato TIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Guadalupe Lobato for an unannounced 1 year required inspection. LPA observed Licensee and 2 preschool age day care children 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 7 adults living in the home; Licensee, husband (Saul Vega), Niece (Sadi Lobato Vega), Jose Lobato Albor (brother), Jose Lobato (nephew), Son (Saul Antonio Vega) and daughter (Alejandra Vega Lobato) and Licensee's two minor daughters; ages 14 and 11.

A review of staff records on December 21, 2022 indicates that all 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. 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.

Guadalupe's certifications for CPR and First Aid are current and expire on April 2023. Licensee has immunization against pertussis and measles. Licensee states she is going to obtain her influenza vaccine next week. Guadalupe completed the mandated reporter training on March 26,2022.

LPA reviewed the Child Care Facility Roster; roster is current. The Fire/Disaster drill log was reviewed during today's inspection; The last fire/disaster drill was completed on 12/12/22.
REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 12/22/2022):
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2022
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: 12/22/2022
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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, garage , laundy areaand left side yard. LPA notes that the sliding door leading to the off limit outdoor area is locked. LPA reminded Guadalupe that the door must be locked to prevent children to access the off limit side yard. The Licensee has a working telephone in the home; Guadalupe 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.

Licensee stated she does not transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size. Licensee states she has two pet dogs; up to date with the vaccines. Licensee states there are no weapons in the home.

LPA discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Exit interview conducted and report was reviewed with the Licensee, Guadalupe Lobato.

No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
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