444410974-7-25-2023-07-CC-EBEN-CU3P2E-20230725105545

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444410974
Report Date: 07/19/2023
Date Signed: 07/25/2023 10:56:43 AM

Document Has Been Signed on 07/25/2023 10:56 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:	HERNANDEZ, OLGA		FACILITY NUMBER:	444410974
ADMINISTRATOR:	OLGA HERNANDEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 840-1423
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 4	DATE:	07/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Olga Hernandez		TIME COMPLETED:	04:45 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, Olga Hernandez and explained the nature of today's inspection to her. Also present during the inspection was Licensee's daughter, Daisy, Licensee's husband, Luis Mares and 3 day care children (1 preschooler and 2 school age) licensee's 5 year old grandson. Days and hours of operation are Monday - Saturday 6:00 AM to 6:00 PM. Licensee states there are 4 adults living in the home (Christopher Mares, Luis Mares, Daisy Mares and Licensee). Licensee's 5 year old grandson lives 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 (patio) area of the family child care home. Off limit areas in the home are four bedrooms, bathroom in master bedroom, hallway closets, closet next to entry door which is locked and used to store cleaning products. No bodies of water observed. Licensee states there are no firearms or other dangerous weapons in the home. Detergents, cleaning compounds, medication, and other items which could pose danger to children are stored where they are inaccessible to children. Licensee understands that poisons are to be locked. No fireplaces or open face heaters in the home. The fire extinguisher (2A10BC) and smoke detector meet state fire marshal standards and was serviced on 04/14/23. The smoke and carbon monoxide detector was tested and proved to be functioning and meets the statutory requirements. Last practiced fire drill was on 06/07/23. 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 (cell phone) in the home.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

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: HERNANDEZ, OLGA	FACILITY NUMBER: 444410974
	VISIT DATE: 07/19/2023

NARRATIVE

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LPA reviewed four (4) 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 uses LIC282, affidavit for liability insurance.
LPA reviewed Licensee's and Assistants file (Christopher Mares, Daisy, Luis Mares). Licensee and assistants have immunization for measles, pertussis. Licensee's Mandated Reporter Training expires 02/27/2025. Luis Mares has Mandated Reporter Training expiring on 02/27/25. LPA informed Licensee that Christopher and Daisy are to completed the mandated reporter training. Licensee has CPR and First Aid expires on 07/24/24. Assistant (Luis Mares) Mandated Reporter Training expires on 02/27/25.

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.

Licensee, Olga Hernandez 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, Olga Hernandez.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 07/25/2023 10:56 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: HERNANDEZ, OLGA	FACILITY NUMBER: 444410974
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review the licensee did not comply with the section cited above; assistant Christopher Mares does not have the Mandated Reporter Training on file. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/26/2023
	Plan of Correction
1 2 3 4	Licensee agrees to have her son/assistant Christopher Mares complete the Mandated Reporter Training by plan of correction date of July 26, 2023.

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above; infant in care does not have the LIC9227 in file. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/26/2023
	Plan of Correction
1 2 3 4	Licensee agrees to have parent complete the LIC9227. Licensee agrees to submit a copy to LPA by plan of correction date of 07/26/23.

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: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

LIC809 (FAS) - (06/04)

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