444409098-1-29-2020-07-CC-EBEN-BLAUGN-20200129143438

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444409098
Report Date: 01/21/2020
Date Signed: 01/29/2020 02:34:45 PM

COMPREHENSIVE INSPECTION

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, MIZAIDA		FACILITY NUMBER:	444409098
ADMINISTRATOR:	MIZAIDA GUZMAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 423-3826
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95060
CAPACITY:	14	CENSUS: 5	DATE:	01/21/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Mizaida Guzman		TIME COMPLETED:	02:20 PM

NARRATIVE

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Licensing Program Analyst (LPA) Elizabeth Berumen conducted 1 year required inspection. LPA met with Licensee, Mizaida Guzman and informed her of the reason for today's inspection. Also present was Assistant, Glady Arana and 5 day care children; one infant and four preschoolers. The hours of operation are Monday - Thursday, 8:00 AM - 5:00 PM and Friday's 8:00 AM - 4:00 P<. Licensee and her husband are the only adults living in the home. Mizaida Guzman has 2 children ages 17 and 14. A review of staff records on January 16, 2020 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 inspection. LPA reviewed roster and fire disaster drill log; last practiced drill was today, 01/21/20. 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), 2 bedrooms and one hall way bathroom, dining room and kitchen. Licensee has a gate to prevent children from accessing the kitchen area. Licensee states that she is remodeling her kitchen; she is removing a wall, once completed she will turn in an updated facility sketch. LPA reviewed 5 children files; all five files are missing the consent for Medical Treatment (LIC 627) in their file. LPA observed that the backyard is clean and safe for children. Storage shed is locked and off limits. Backyard is fenced all around- left and right side yards are off limits and fenced off to prevent children from accessing those off limit area.

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 Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

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: GUZMAN, MIZAIDA	FACILITY NUMBER: 444409098
	VISIT DATE: 01/21/2020

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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 and shall be completed on or before March 26, 2020.

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.
NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

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: GUZMAN, MIZAIDA	FACILITY NUMBER: 444409098
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/21/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/04/2020 Section Cited	1 2 3 4 5 6 7	102417(g)(7) Operation of a Family Child Care Home. A (completed) emergency information card shall be maintained for each child ... This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on children's file reviews Licensee failed to provide Consent for Medical Treatment forms for children 1-5. This poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
	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: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

LIC809 (FAS) - (06/04)

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