444411947-9-25-2019-07-CC-EBEN-BGCPAE-20190925110837

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444411947
Report Date: 09/20/2019
Date Signed: 09/25/2019 11:09:11 AM

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:	FERNANDEZ, BERTHA		FACILITY NUMBER:	444411947
ADMINISTRATOR:	FERNANDEZ, BERTHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 761-0723
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 0	DATE:	09/20/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Bertha Fernandez		TIME COMPLETED:	11:00 AM

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 annual random inspection. LPA met with Licensee, Bertha Fernandez explained the nature of today's inspection to her. No day care children were present during the visit. Bertha states she is caring for school age children. Bertha states she starts picking up the first child from school at 2:30 PM and leaves children with her adult daughter, Corina Rocha. Licensee states there are three adults living in the home; herself, her husband and adult daughter. The day-care is open Monday thru Friday from 6:00 AM to 6:00 PM. LPA reviewed Licensee's and Corina Rocha's files. Licensee has current CPR/First Aid expiring on May 2020. Bertha completed the Mandated Reporter Training on 10/9/18. Corina has CPR & First Aid certifications expiring, 03/2021. LPA informed Licensee that Corina is required to complete the Mandated Reporter Training. It is available in English on line at MandatedReporterCA.com. Corina Rocha does not have proof of immunization against pertussis, measles and influenza. LPA inspected the on limit indoor and outdoor areas of the home. The off limit areas in the home are: entire upstairs (3 bedrooms, 2 bathrooms) and garage. LPA observed barricaded stairs. The home is equipped with a 3A40BC fire extinguisher. The smoke and carbon monoxide detectors , functioning carbon monoxide detector. The back patio is fenced and no bodies of water were observed. LPA observed a covered electric fire place in the living room. The child care facility roster was not available for review. Fire disaster drill log was reviewed; last practiced drill was 06/19/19. Poisons, detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children are inaccessible to children. LPA reminded her that since she cares for school age children she is to ensure such items are inaccessible. LPA recommended Licensee to store items in locked garage. Licensee states there are no weapons 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: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

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: FERNANDEZ, BERTHA	FACILITY NUMBER: 444411947
	VISIT DATE: 09/20/2019

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Supervision of children was discussed with Licensee and she understands that she must be present in the home during 80% of the day care hours and ensure that the children are supervised at all times. The Licensees understand her capacity options and understands that she can not have more than 14 children in the home at any time with a qualified adult present. Bertha Fernandez states that she does transport children and understands that children are not to be left alone in vehicles and car safety seat law.

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 will mail Licensee the, Effects of Lead exposure flyer so she can handout to parents.

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.

Deficiencies cited on following page 809D:

LPA conducted an exit interview with Licensee, Bertha Fernandez in Spanish 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: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: FERNANDEZ, BERTHA	FACILITY NUMBER: 444411947
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/20/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/04/2019 Section Cited	1 2 3 4 5 6 7	A person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on inspection of personnel files, License;s daughter (Corina Rocha) does not have immunization against pertussis, measles and influenza which poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
Type B 10/04/2019 Section Cited	1 2 3 4 5 6 7	Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Licensee did not have a child care facility roster available for LPA's review.	8 9 10 11 12 13 14	requirement of maintaining a current roster.

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: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3