444409057-10-9-2021-07-CC-EBEN-C7MNTY-20211009104527

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444409057
Report Date: 10/08/2021
Date Signed: 10/09/2021 10:46:02 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:	FERNANDEZ, MARIA		FACILITY NUMBER:	444409057
ADMINISTRATOR:	MARIA FERNANDEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 254-3191
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 9	DATE:	10/08/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Maria Fernandez		TIME COMPLETED:	11:45 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, Maria Fernandez for unannounced Required – 1 year annual inspection (KIT 2). LPA was granted access to the home by the Licensee. LPA notes that the home is located in mobile home park; space 39 is located on the last street of the mobile home park. LPA also observed Licensee's spouse (Gerardo) and 1 infant and 8 preschool children in the home during today's inspection. The Licensee was operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. The Licensee, her spouse (Gerardo) her adult daughter (Karina) are the adults residing in the home. Licensee's 5 month old grandson also lives in the home. Licensee will submit an updated LIC 279 and LIC 279 b to update her facility file. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on July 21, 2021. The Licensee has the required vaccinations (MMR, Tdap, & flu) and is current with the Mandated Reporter Training for Child Care Workers; certificate expires on March 24, 2023. The Licensee's CPR and First Aid certifications expiring 02/16/2023. Licensee's assistant (Gerardo Fernandez) has TB, employee rights, criminal record statement, measles and pertussis immunization's and mandated reporter training expires on March 24, 2023. Safe sleep update: LPA discussed the new “Safe Sleep” regulations with the Licensee and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensee. LPA reminded the Licensee that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects. LPA inspected the on-limit indoor and outdoor areas of the home during today's inspection. Off limit areas are two bedrooms (one bathroom in master bedroom) and hallway closet. The laundry room area is used for children to pass through the patio area. Patio area is fenced; the storage shed is off limits to children. The Licensee has a working telephone in 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. There is a heater located in laundry area- the heater has a mesh screen. There are no stairs inside the home.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

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: FERNANDEZ, MARIA	FACILITY NUMBER: 444409057
	VISIT DATE: 10/08/2021

NARRATIVE

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LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors and no bodies of water. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Any poisons are locked and inaccessible to the day care children. LPA observed that in laundry room; Licensee has a locked storage area for poisons and toxins). The Licensee states that she does not administer any medication to the day care children at this time.

A review of staff records on October 8, 2021 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 the 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.

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 without two fully qualified adults present. The Licensee states that does not transport any day care children. The Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

LPA conducted an exit interview with the Licensee prior to the conclusion of today's inspection. Licensee's email address is patriciarmendezf67@gmail.com
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: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

LIC809 (FAS) - (06/04)

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