444409058-8-2-2019-07-CC-MBED-BENN7M-20190802101259

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444409058
Report Date: 07/24/2019
Date Signed: 08/02/2019 10:13:05 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:	HERRERA, FLORENCIA		FACILITY NUMBER:	444409058
ADMINISTRATOR:	FLORENCIA HERRERA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 740-2288
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 11	DATE:	07/24/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Florencia Herrera		TIME COMPLETED:	01:45 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	Unannounced random visit made by Mahvash Behbood. Met licensee Florencia, purpose of the visit explained. Present also were 11 day care children, one under 2 , two over 2 and the rest school age. Her helper and her adult son were present as well. Days and hours of operation is M through F from 6 AM to 6 PM. Inside and outside of the home inspected. children file reviewed. There is no staff file. There are no bodies of water on the property. Licensee stated there are no gun at home. No fire place in day care area. Fire extinguisher is the correct size. Smoke and carbon monoxide are operational. Toys and play equipment are age appropriate. Discussed with licensee children are not to be left in parked vehicles. Backyard where children play has 3 feet fence. Licensee's roster must be updated. There is an emergency information on file for children who have paper work, 3 children didn't have any paperwork. The fire/disaster drill log is not updated, last date documented was 06/18/19. Living in the home are: licensee, her husband, her adult son, her 13 year old son, her mother and father in laws. All adults have fingerprint clearance. CPR and First Aid is expires on 06/25/2018. Staff and licensee didn't have proof of immunization. Licensee stated she is not providing Incidental Medical Services. Off limits: The entire ground level, Living room, the bedrooms located on the level the day care room is. Discussed with licensee, the requirement to visit annually now and the repeated violation within 12 months will result is $250 civil penalty. Effect of lead exposure poster was provided to licensee and for their information and to share with children. Discussed also was safe sleep. See next page for citation under Title 22.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash Behbood	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019

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: HERRERA, FLORENCIA	FACILITY NUMBER: 444409058
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/24/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/09/2019 Section Cited CCR 102417(9(A)(1)	1 2 3 4 5 6 7	Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. The last drill documented was on 06/18/18. This is potentially dangerous to the health and safety of children.	1 2 3 4 5 6 7	Licensee to conduct Fire Drill at least twice a year and document it. must be corrected no later than 08/09/19.
Type B 08/09/2019 Section Cited CCR 1597.622	1 2 3 4 5 6 7	Commencing September 1, 2016, a person shall not be employed or volunteer at a FCCH if he or she has not been immunized against influenza, pertussis, and measles. Licensee and her helper do not have proof of pertussis, measles and influenza vaccines. This is potentially dangerous to the health and safety of children.	1 2 3 4 5 6 7	Must be corrected no later than 08/09/19.
Type B 08/09/2019 Section Cited CCR 102421(a)	1 2 3 4 5 6 7	The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). Child #1, 2 and 3 don't have any paperwork. This is potentially dangerous to the health and safety of children.	1 2 3 4 5 6 7	Must be corrected no later than 08/09/19.
Type B 08/09/2019 Section Cited CCR 1596.8662(b)	1 2 3 4 5 6 7	Health and Safety - Mandated Child Abuse Reporter Training - Neither licensee nor any of her declared helper had proof of completion of the mandated child abuse reporter training. This is potentially dangerous to the health and safety of children.	1 2 3 4 5 6 7	Must be corrected no later than 08/09/19.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash Behbood	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: HERRERA, FLORENCIA	FACILITY NUMBER: 444409058
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/24/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/24/2019 Section Cited CCR 102417(a)	1 2 3 4 5 6 7	Operation of Family Child Care Home- The licensee shall be present in the home and shall ensure that children in care are supervised at all times. Children playing in the play yard without and adult present. the play yard is located on the street level and the homeis on the second level. This is an immediate danger to health and safety of children.	1 2 3 4 5 6 7	Licensee sent her adult son to the playground to supervise. She agrees during the visit to provide supervision in the playground by an adult being present due to lacation of the play are.
Type A 07/24/2019 Section Cited CCR 102417(g)(4)	1 2 3 4 5 6 7	Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children. Medication name Levothroyin was on the counter accessible to children, as well dog food.	1 2 3 4 5 6 7	Medication was removed from the counter. Licensee to store dog food inaccessible to children.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash Behbood	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019

LIC809 (FAS) - (06/04)

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