444409343-7-14-2021-07-CC-FCJO-C4WTZQ-20210714151042

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444409343
Report Date: 07/14/2021
Date Signed: 07/14/2021 03:10:48 PM

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:	ROCHA, BERTHA		FACILITY NUMBER:	444409343
ADMINISTRATOR:	BERTHA ROCHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 722-2183
CITY:	FREEDOM	STATE: CA	ZIP CODE:	95019
CAPACITY:	14	CENSUS: 11	DATE:	07/14/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Bertha Rocha		TIME COMPLETED:	03:15 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	Licensing Program Analysts (LPA) Fermin Campos-Jaramillo met with Licensee, Bertha Rocha for an unannounced one year required inspection. Licensee's adult daughter/helper Carina Rocha was also present and assisting with the children. LPA observed 11 day care children; including 8 preschoolers and 3 school-age present during today's inspection. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. Licensee, Bertha Rocha states there are 6 adults living in the home; herself, her husband Rigoberto, her in law Alonso, and her three adult children, Carina, Berenise, and Rigoberto Jr. LPA inspected the indoor and outdoor areas of the home today. The main areas of the day care are the back day care room. LPA notes that the entrance to day care room is on the left side of the home. Licensee also uses the front living room area. LPA observed barricaded stairs. Off limit areas inside the home are: three upstairs bedrooms, downstairs bathroom, laundry closet and garage. The off limit areas outside of the home are 4 storage sheds. LPA observed that the shed doors are locked and are also fenced off to prevent children from accessing the areas. Licensee has cactus in the backyard which are fenced off to prevent children from touched and potentially sustain an injury. Licensees has a working telephone in the home. LPA observed sufficient materials, toys, and equipment for the day care children. The home is clean, orderly, and safe for the day children. LPA observed a fully charged 2A10BC fire extinguisher last time serviced on 2/03/21. LPA tested the smoke and carbon monoxide detectors; both proved to be working. The backyard is fenced and there are no bodies of water. The Licensees state that they do not have any weapons. Licensee has a pet dog. LPA observed that storage areas for detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Poisons are stored in one of the locked storage sheds. LPA observed that Licensee's laundry room is also locked. REPORT DATED 07/14/21 continues on page 2.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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: ROCHA, BERTHA	FACILITY NUMBER: 444409343
	VISIT DATE: 07/14/2021

NARRATIVE

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REPORT DATED 07/14/21 continues from page 1.

LPA reviewed fire/disaster drill log; last practiced was documented on 6/14/21. LPA reviewed and obtained a copy of the Child Care Facility Roster. LPA reviewed 5 children files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file.
Licensee has completed the Mandated Reporter Training for Child Care Workers on 2/25/20, and her assistant on 5/29/20. Both Carina and Bertha have immunization against pertussis and measles. Licensee has current
CPR & First aid, expiring on 1/30/23 and her helper expiring on 4/17/23.

A review of staff records on 7/13/21 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 Bertha Rocha 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.
The Licensees understand her capacity options and understands that she can not have more than 14 children in the home at any time with a qualified adult present. Bertha Rocha states that she does not transport children via vehicle. Licensee states that she does provide Incidental Medical Services – IMS. No child currently enrolled requires IMS. IMS plan is in facility file.
LPA advised licensee of the new regulations on Safe sleep for infant children. and provided licensee with form LIC9227. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.
LPA provided licensee with the Lead Poisoning Facts sheet.
There were not deficiencies cited during today's inspection. Licensee's rights form was printed and was handed to Licensee. Exit interview was conducted with licensee in Spanish.

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: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC809 (FAS) - (06/04)

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