444411935-9-17-2019-07-CC-EBEN-BG4T36-20190917142150

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444411935
Report Date: 09/13/2019
Date Signed: 09/17/2019 02:22:11 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:	MARIN-ROMERO, MARIA		FACILITY NUMBER:	444411935
ADMINISTRATOR:	MARIA MARIN-ROMERO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 768-7211
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 5	DATE:	09/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Maria Marin-Romero		TIME 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 met with Licensee, Maria Marin-Romero for an annual/random inspection. LPA observed five preschool age children and Licensee's mother, Maria Gloria Romero. Days and hours of operation are Monday to Friday 6:00am to 6:00pm. The adults that reside in the home are licensee, her husband, adult son and daughter and 16 year old son. A review of staff records on 09/10/19 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 Licensee 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 licensee's file. Licensee's certifications for CPR and First Aid are current and expire on 09/03/20. Licensee has immunization's against pertussis, measles and declined the influenza vaccine, a signed declaration was reviewed today, dated 08/26/19. Maria Marin-Romero completed the Mandated Reporter Training on March 18, 2019. LPA reviewed five children files; all files contain the required documents- signed by parents including immunization and parents rights form. LPA inspected the on limit indoor and outdoor areas of the home during today's visit. Off limit areas in the home are two bedrooms, hall closet and garage. Off limit areas outside the home is the locked storage shed. LPA reviewed Child Care Facility Roster during today's visit. LPA reviewed the Fire/Disaster drill log, last drill conducted on 09/10/19. The Licensee has a working telephone (land line) in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly and safe for the day care children. LPA observed two barricaded wall heaters.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019

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: MARIN-ROMERO, MARIA	FACILITY NUMBER: 444411935
	VISIT DATE: 09/13/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 09/13/2019):

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detector, and no bodies of water. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medication and other similar items are stored inaccessible to children.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time; when more than 8 children an assistant is required.

The Licensee states that does not transport children however she understands that children cannot be left unattended in a vehicle.

This facility provides Incidental Medical Services – IMS. Licnesee states that no child enrolled is in need of Incidental Medical Services.

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the Licensee.

No deficiencies issued during today's inspection.

LPA conducted an exit interview with the Licensee prior to the conclusion of today's inspection

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019

LIC809 (FAS) - (06/04)

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