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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444411318
Report Date: 08/06/2019
Date Signed: 09/03/2019 12:23:06 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:DIAZ, VERONICAFACILITY NUMBER:
444411318
ADMINISTRATOR:DIAZ, VERONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-1815
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 13DATE:
08/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Veronica DiazTIME COMPLETED:
03:35 PM
NARRATIVE
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Analyst Behbood met with licensee Veronica Diaz. Present also were 13 day care children, including 1 infant and 3 school age and her assistant. Living in the facility are licensee, her husband and 1 adult sons. Days and hours of operation are Monday through-Friday, from 6 AM to 6 PM.
All adults living in the home have criminal record clearance as well as child abuse index. They all meet TB test requirement.
LPA and licensee toured both inside and outside of the home. There are no bodies of water present. Licensee states that there are no firearms/weapons in the home. Medicines, poisons and cleaning supplies are inaccessible to the children. There is a fully charged fire extinguisher, operational smoke and carbon monoxide detector. Home appears clean, has proper heating, lighting and ventilation for safety and comfort. LPA observed safe and sufficient toys, play equipment, materials and supplies for the day-care. Telephone is in working order. Licensee understands smoking is prohibited. Licensee identified the following off limit area inside the home: entire second floor, 2 bedrooms and one bathroom in first floor and family room. Off limit area outside: the fenced side yard with the storage shed. The playground is fenced with adequate toys.
Supervision of children was discussed with the licensee and she understands that she must be present in the home 80 percent of the time during day care hours and ensure that the children are supervised at all times.
Licensee has current CPR and First Aid that expires in 05/2020. Licensee have proof of the required immunization on file. She has an up to date children's roster. The fire drills are documented. Children were supervised during the visit. .
Effect of lead exposure poster was provided to licensee and for their information and to share with children. Discussed also was safe sleep.

Citation dismissed due to her helper being Spanish Speaking.

SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
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)
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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: DIAZ, VERONICA
FACILITY NUMBER: 444411318
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
08/23/2019
Section Cited

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Health and Safety - Mandated Child Abuse Reporter Training - Her helpers haven't completed the Mandated Child Abuse Reporter. This is potentially dangerous to health and safety of children.

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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
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)
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