444410974-6-26-2019-07-CC-EBEN-BDHQKN-20190626121438

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444410974
Report Date: 06/25/2019
Date Signed: 06/26/2019 12:14:46 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:	HERNANDEZ, OLGA		FACILITY NUMBER:	444410974
ADMINISTRATOR:	OLGA HERNANDEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 536-5053
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 11	DATE:	06/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Olga Hernandez		TIME COMPLETED:	01:30 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 met with Licensee, Olga Hernandez and explained the nature of today's inspection to her. LPA observed 3 adults in the home and 11 children; 1 infant 5 preschoolers and 5 school age. Licensee's 14 year son and 16 year old foster daughter were also present during the inspection. Days and hours of operation are Monday through Sunday 6:00 AM to 11:45 PM. Licensee states there are 4 adults living in the home; herself, her husband (Luis Mares), and licensee two adult daughters (Daisy and Roxanna Mares). A review of staff records 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 the Olga Hernandez 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. Licensee has a valid Foster Care License, #0F06801L9 , capacity 2, effective 04/19/12. Licensee and LPA inspected the on limit indoor and outdoor areas of the home. Licensee states that 4 bedrooms are off limits. Olga asked LPA if she could make the bathroom in master bedroom accessible to children when hall way bathroom is occupied. LPA inspected the master-bedroom and observed toiletries accessible to children and perfumes on her dresser. Olga agreed to remove the items and store them inaccessible to children. Olga will update her facility sketch and make that area accessible to children. No bodies of water were observed. Licensee states there are no firearms in the home. LPA observed a fully charged 3A40BC fire extinguisher. The smoke and carbon monoxide detectors were tested and proved to be functioning. The home is clean, orderly, with heating and ventilation for safety and comfort. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children are stored where they are inaccessible to children. Licensee has cell phone; (831)840-1423. LPA reviewed and obtained a copy of facility roster. LPA reviewed fire disaster drill log; last practiced drill was March 6, 2019. LPA reviewed Licensee's and her husbands file during today's inspection. Luis Mares has current CPR & First Aid expiring 04/2020. Luis Mares has immunization against pertussis and measles. Licensee's CPR & First Aid expires on 01/2020. LPA reviewed children files. Licensee is using affidavit for liability insurance (LIC282). All files contained the Identification and Emergency Information (LIC700).

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019

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: HERNANDEZ, OLGA	FACILITY NUMBER: 444410974
	VISIT DATE: 06/25/2019

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Licensee and Luis Mares completed the mandated reporter, AB1207 compliant training on April 16, 2018. Licensee understands the course it to be renewed every two years.

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 emailed Licensee link to access information.

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 in Spanish. 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.

No deficiency cited.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019

LIC809 (FAS) - (06/04)

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