444410144-7-25-2023-07-CC-EBEN-CU3P9A-20230725110648

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444410144
Report Date: 07/20/2023
Date Signed: 07/25/2023 11:08:30 AM

Document Has Been Signed on 07/25/2023 11:08 AM - 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:	CHAVEZ, ESTHER		FACILITY NUMBER:	444410144
ADMINISTRATOR:	ESTHER CHAVEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 722-8622
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 7	DATE:	07/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Esther Chavez		TIME COMPLETED:	01:00 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 unannounced 1 year required inspection to the home today. LPA met with Licensee, Esther Chavez and explained the nature of today's inspection to her. Also present during the inspection was Licensee's assistant, Delia Brenes Diaz and 7 day care children (3 infants 3 preschoolers and one school age). Days and hours of operation are Monday - Saturday from 6:00 AM to 6:00 PM. Licensee states that she is the only adult living in the home. Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 inspected the indoor and outdoor area of the family child care home. There are two bedrooms in the home and Licensee uses one for day care. Off limit areas are- one bedroom and garage. Off limit areas outside are two storage sheds and fenced off area on the right side of the backyard. LPA notes that there is a fenced preventing children to access storage sheds and off limit areas of the backyard. No bodies of water observed. Licensee states there are no firearms or other dangerous weapons in the home. No pets. No fireplaces or open face heaters in the home. The fire extinguisher (3A40BC) and smoke detector meet state fire marshal standards and was serviced on 02/20/23. The carbon monoxide detector was tested and proved to be functioning and meets the statutory requirements. The Last practiced fire/disaster drill was on 07/11/23. Poisons, detergents, cleaning compounds, medicines and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. LPA observed a few nail polishes in bathroom mirror cabinet; LPA advised Licensee to remove those items and store them in an inaccessible place where they are out of reach of children.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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: CHAVEZ, ESTHER	FACILITY NUMBER: 444410144
	VISIT DATE: 07/20/2023

NARRATIVE

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LPA observed the home to be clean and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home. LPA observed safe toys, play equipment, and materials. LPA reviewed facility roster. Licensee has a working telephone and provider her cell number (831) 254-6630.

LPA reviewed seven (7) children’s files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), and Immunization Records. Licensee carries day-care insurance. Infants are missing the 15 minute sleep checks.

LPA reviewed Licensee's and Assistant (Delia Bernes Diaz) file. Licensee has immunization's for measles, pertussis. Licensee's Mandated Reporter Training expires 08/22/24 . LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years. Licensee has CPR and First Aid expires on 01/21/25. Licensee's Assistant (Delia) has current CPR & First Aid expiring 01/21/25. Assistants Mandated Reporter Training expires on 03/13/25. Licensee and Assistant have a signed paper stating they declined the influenza vaccine this season. Delia has TB test on file and has immunization against measles and pertussis.

LPA provided and 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 reminded 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 she registers all infant devices with the CPSC to be notified of any recalls on her purchased equipment.

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.

Continuation on next page:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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: CHAVEZ, ESTHER	FACILITY NUMBER: 444410144
	VISIT DATE: 07/20/2023

NARRATIVE

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Licensee, Esther Chavez was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&R's) throughout California.

As a result of today's inspection, deficiencies cited on 809D.

Exit interview conducted and report was reviewed with Licensee, Esther Chavez.

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: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/25/2023 11:08 AM - It Cannot Be Edited

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: CHAVEZ, ESTHER	FACILITY NUMBER: 444410144
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review the licensee did not comply with the section cited above; infant #4,5, and 6 do not have in their file the 15 minute sleep checks which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/27/2023
	Plan of Correction
1 2 3 4	Licensee agrees to submit copies of infants # 4, 5 and 6 sleep checks to Licensing by plan of correction date of July 27, 2023. Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: date, Infant’s name and Time of each 15-minute check.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC809 (FAS) - (06/04)

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