444409343-8-4-2022-07-CC-FCJO-CGYT6V-20220804142746

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444409343
Report Date: 08/04/2022
Date Signed: 08/04/2022 02:27:54 PM

Document Has Been Signed on 08/04/2022 02:27 PM - It Cannot Be Edited

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: 9	DATE:	08/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Bertha Rocha		TIME COMPLETED:	02:40 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 helper Andrea was also present and assisting with the children. LPA observed 9 day care children; including one infant, seven preschool age, and one 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 5 adults living in the home; herself, her husband Rigoberto, her in law Alonso, and her two adult children, Carina, Berenise, and a minor grandchild 4 years old. 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 stated she 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 2/09/22. 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 8/04/22 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: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

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: 08/04/2022

NARRATIVE

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Report dated 8/04/22 continues from page 1.

LPA reviewed fire/disaster drill log; last practiced was documented on 7/05/22. LPA reviewed and obtained a copy of the Child Care Facility Roster. LPA reviewed 14 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 2/17/22 and her assistant Andrea on 6/13/22. Both Andrea and Bertha have immunization against pertussis and measles. Licensee has current CPR & First aid, expiring on 1/30/23 and her helper Andrea expiring on 10/18/22.

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.
A review of staff records on 7/28/22 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Licensee Bertha Rocha was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Report dated 8/04/22 continues on page 3.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

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: ROCHA, BERTHA	FACILITY NUMBER: 444409343
	VISIT DATE: 08/04/2022

NARRATIVE

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Report dated 8/04/22 continuers from page 2.

Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800)514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with licensee Bertha Rocha

No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

LIC809 (FAS) - (06/04)

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