<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444409857
Report Date: 08/06/2019
Date Signed: 08/08/2019 03:15:15 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, MARISOLFACILITY NUMBER:
444409857
ADMINISTRATOR:MARISOL ROCHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 724-7229
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 14DATE:
08/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Marisol RochaTIME COMPLETED:
01:15 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 Analyst (LPA) Elizabeth Berumen conducted an annual random inspection. LPA met with Licensee, Marisol Rocha and explained the nature of today's inspection to her. Also present during inspection was Licensee's husband, Francisco Rocha and 14 day care children. Licensee is operating outside her licensed capacity today. LPA observed 4 infants, 6 preschoolers and 4 school age children.
Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. The adults that live in the home are: Licensee, spouse, Licensee's daughter and son. Licensee has a 12 year old son and 3 month old granddaughter who also live in the home. A review of staff records on July 31, 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 also reminded Marisol 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.

LPA reviewed a Child Care Facility Roster during the inspection. The roster is not up to date; 7 children present are not listed on facility roster. A Fire/Disaster drill log was observed. The last fire/disaster drill was completed on 06/24/19. LPA reviewed 14 children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file.

LPA inspected parts of the facility in which family day care services are being provided and areas which children have access. Off limit areas in the home are: garage and entire upstairs. Stairs are barricaded. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean and orderly. LPA did not observe any fireplaces or wall heaters in the day care areas.

LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. Marisol states that there are no weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 008/06/2019):
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
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 4
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, MARISOL
FACILITY NUMBER: 444409857
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2019
Section Cited
HSC
1596.841
1
2
3
4
5
6
7
Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.
1
2
3
4
5
6
7
Each family child care home shall have a current roster of children. Licensee agrees to update facility roster and mail a copy to LPA by Plan of Correction date of 08/13/19.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: LPA reviewed facility roster which shows that 7 children in care are not listed on the roster as specified in Health and Safety Code Section 1596.841.
8
9
10
11
12
13
14
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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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, MARISOL
FACILITY NUMBER: 444409857
VISIT DATE: 08/06/2019
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
26
27
28
29
30
31
32
CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 08/06/2019):
LPA reviewed Licensee and Francisco's files; Both have proof of immunization's for Measles (MMR), and pertussis (Tdap). Licensee Marisol Rocha completed the Mandated Reporter Training on 11/02/2017. Francisco (husband/assistant) completed the Mandated Reporter Training on 05/24/2019. The Licensee's certifications for CPR and First Aid are current and expire, 10/20/19. Licensee's husband has CPR and First Aid certifications, expiring 10/20/19.
This facility does not provide Incidental Medical Services – IMS.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. 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.

The following deficiencies were observed during today's inspection:


1. LPA observed the licensee was out of ratio, having 4 infants, 6 preschool age children, and 4 school age children. This poses an immediate risk to children in care.
2. Not all children in care are listed on Facility roster.

The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.
Exit interview conducted with Marisol Rocha in Spanish. LPA provided Marisol Rocha a copy of this report and her appeal rights.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE OF THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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, MARISOL
FACILITY NUMBER: 444409857
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/07/2019
Section Cited
CCR
102416.5(d)(1)
1
2
3
4
5
6
7
Staffing Ratio and Capacity

For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:
(1) Twelve children, no more than four of whom may be infants; or (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.
1
2
3
4
5
6
7
Licensee to immediately remain within ratio and capacity. Licensee states she will inform parents and let go of two school age children. Leaving her with 4 infants, 6 preschoolers and 2 School Age Children. Licensee to send a written plan of correction to the Department by POC due date of 08/07/19.
8
9
10
11
12
13
14
No more than three infants are cared for during any time when more than 12 children are being cared for.
Requirement was not met as evidenced by.
8
9
10
11
12
13
14
Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

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

DATE: 08/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4