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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444409098
Report Date: 06/14/2019
Date Signed: 06/18/2019 11:55:05 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:GUZMAN, MIZAIDAFACILITY NUMBER:
444409098
ADMINISTRATOR:MIZAIDA GUZMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 423-3826
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:14CENSUS: 10DATE:
06/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Mizaida GuzmanTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Berumen conducted an unannounced Annual Random inspection. LPA met with Licensee, Mizaida Guzman and informed her of the reason for today's inspection. Also present was Assistant, Glady Arana and 10 day care children.

The hours of operation are Monday - Thurday, 8am - 4pm and Friday's 8 am - 4 pm. Licensee and her husband are the only adults living in the home. Mizaida Guzman has 3 children ages 16 and 13. A review of staff records on June 13, 2019 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 inspected the indoor and outdoor areas of the home during today's visit. LPA reviewed a current Child Care Facility Roster and obtained copy. LPA reviewed fire disaster drill log; last practiced drill was September 1, 2018. LPA reminded Mizaida Guzman that fire disaster drills are to be practiced once every six months. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the children in care. The home is clean, orderly, and safe for the day care children. Off limit areas in the home are as follows: detached garage (studio), 3 bedrooms and one hall way bathroom, dining room and kitchen. Licensee is using two bedrooms today that were not approved by Licensing. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care must be reported to Licensing before the area can be used. Licensee Mizaida agrees to submit an updated facility sketch to the Department.

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 weapons in the home. All detergents, cleaning compounds, poisons, medications, and other similar items are out of reach and inaccessible to children.

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

DATE: 06/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2019
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 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: GUZMAN, MIZAIDA
FACILITY NUMBER: 444409098
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2019
Section Cited
CCR
102416.3(a)(6)
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Alterations to Existing Buildings or Grounds
Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
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Licensee agrees to submit an updated facility sketch circling the rooms to be used for day care. Today LPA approved one room for day care use.
Plan of correction date 06/28/19.
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This requirement was not met as evidenced by: LPA observed 4 children sleeping in off limit bedroom and one child sleeping in another off limit room. This is a potential health and safety risk to children in care.
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Type B
06/28/2019
Section Cited
CCR
102417(g)(9)(a)
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Operation of a Family Child Care Home
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.
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Licensee agrees to practice a fire disaster drill, document it and send copy to LPA. Licensee also to write a statement stating she understands the regulation and requirement to practice fire/disaster drill logs by plan of correction date of 06/28/19.
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This requirement was not met as evidenced by: LPA reviewed fire disaster drill log; the last practiced and documented drill was on Septemeber 1, 2018. This is a potential health and safety risk to children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2019
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: GUZMAN, MIZAIDA
FACILITY NUMBER: 444409098
VISIT DATE: 06/14/2019
NARRATIVE
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LPA reviewed Licensee's and helper, Gladys Arana files. Both have immunization against pertussis and measles. Glady's has immunization against influenza and Licensee declines the vaccine. Licensee has certification for CPR & First Aid, expiring on March 3, 2020. Mizaida Guzman completed the Ca Child Abuse Mandated Reporter Training (AB1207) on March 26, 2018 and Gladys Arana completed the training on March 26, 2018. LPA reminded Mizaida Guzman that the training is to be completed every two years.

Supervision of children was discussed with Licensee, Mizaida Guzman 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. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time. Licensee states that she does not transport children. Car safety seat law was discussed.
Licensee states that she is currently not provided incidental medical services (IMS). Licensee understands the requirement of having an Incidental medical service plan before providing children incidental medical services.

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. LPA provided Licensee with, Effects of Lead exposure flyer to handout to parents.

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. A copy of this report was provided to the Licensee at the conclusion of the inspection.
deficiencies cited on 809D.

NOTICE OF SITE VISIT WAS ISSUED 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: 06/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3