444412309-3-20-2025-07-CC-DBAS-DEXMJM-20250320093922

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444412309
Report Date: 03/18/2025
Date Signed: 03/20/2025 09:40:45 AM

Document Has Been Signed on 03/20/2025 09:40 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	DELGADILLO, JACQUELINE		FACILITY NUMBER:	444412309
ADMINISTRATOR/ DIRECTOR:	DELGADILLO, JACQUELINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 724-4648
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 3	CENSUS: 3	DATE:	03/18/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:50 PM
MET WITH:	Jacqueline Delgadillo		TIME VISIT/ INSPECTION COMPLETED:	03:45 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

On March 18, 2025, Licensing Program Analyst (LPA) Darnella Barnes conducted an unannounced annual random inspection. The purpose was explained to the licensee, who granted access. and received the Entrance Checklist (LIC 126).

The facility operates Monday through Friday, 7:00 a.m. to 5:00pm. Required postings were visible, and the last fire/disaster drill was on 1/16/2025 The licensee was reminded of the six-month drill and documentation requirement.

Licensee, and 2 infants and 1 preschooler were present, meeting capacity and ratio requirements. The licensee was reminded of supervision, reporting obligations, and that children’s rights cannot be waived. Both infants were sleeping in their individual cribs that met all regulations.

Licensee, spouse, and daughter all live in the home and have fingerprint clearances. Licensee’s son who is also living in the home is now of legal age 18 years and has not obtain fingerprint clearance. Licensee will obtain fingerprint clearance for her son immediately.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Childcare Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Susy Cervantes	TELEPHONE: (408) 324-2152
Darnella Barnes	TELEPHONE: 916-896-4593
	DATE: 03/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: DELGADILLO, JACQUELINE	FACILITY NUMBER: 444412309
	VISIT DATE: 03/18/2025

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
26
27
28
29
30
31
32

PAGE 2

LPA toured the facility, indoor off-limit areas all of second floor, kitchen and closet. Outside off-limits side yards left and right...

Observations included a fully charged 3A-40B-C fire extinguisher, last serviced 5/30/24, working smoke and carbon monoxide detectors, and a working telephone. The home was clean, well-ventilated, and stocked with safe, age-appropriate toys. . All poisons, detergents, cleaning compounds, medicines were stored out of children’s reach.

The fenced backyard contained age-appropriate, well-maintained equipment, playhouse, bikes, picnic table and chalk board.

Smoking, baby walkers, bouncers, jumpers and similar items are prohibited in the daycare. The licensee confirmed no guns or ammunition are in the facility. The licensee was reminded to notify licensing before making any changes to the house or yard.

Licensee’s CPR/First Aid certification expires on 7/31/27. The preventive health certification is on file for licensee, and mandated reporter training expires 4/27/26. Reminded the licensee of the two-year renewal requirement.

The facility roster and three children’s files were reviewed, confirming all required forms were complete, including the affidavit regarding liability insurance (LIC 282). The licensee confirmed no liability insurance at this time.

Children showing signs of illness must be separated from others until the parent or guardian arrives.

The licensee does transport children, LPA viewed licensee’s current driver’s license. LPA also reminded the licensee that children cannot be left unattended in vehicles and that car seats and booster seats must be available for safe transportation.

SUPERVISOR'S NAME: Susy Cervantes	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Darnella Barnes	TELEPHONE: 916-896-4593
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: DELGADILLO, JACQUELINE	FACILITY NUMBER: 444412309
	VISIT DATE: 03/18/2025

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
26
27
28
29
30
31
32

PAGE 3

Safe Sleep Information was provided and licensee was reminded that an Individual Infant Sleeping Plan (LIC 9227) is a required for each infant up to 12 months old, with nap checks documented until age two. Cribs and play yards must be free of loose items, bumper pads, and hanging objects and mattresses must be firm, properly fitted, and have fitted sheets.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed 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 they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was reminded Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, inspection the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care- licensing/subscribe and select the Child Care option to receive email communication.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (8004314-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISOR'S NAME: Susy Cervantes	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Darnella Barnes	TELEPHONE: 916-896-4593
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: DELGADILLO, JACQUELINE	FACILITY NUMBER: 444412309
	VISIT DATE: 03/18/2025

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
26
27
28
29
30
31
32

LAST PAGE

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please inspection the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During the exit interview, the Licensee confirmed no Registered Sex Offenders reside at the facility. The LPA completed the RSO profile in FAS on 1/3/25. A search of the California Attorney General-Megan’s Law website found no registered sex offenders at the facility address.

During today’s inspection, (1) “Type B” deficiency was identified on attached 809-D. Appeal rights provided.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee..

SUPERVISOR'S NAME: Susy Cervantes	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Darnella Barnes	TELEPHONE: 916-896-4593
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 03/20/2025 09:40 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: DELGADILLO, JACQUELINE	FACILITY NUMBER: 444412309
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

102416.2(a)(2)

Reporting Requirements

(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). (2) Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/25/2025
	Plan of Correction
1 2 3 4	Licensee will provide clearance by 1/25/2025

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Susy Cervantes	TELEPHONE: (408) 324-2152
Darnella Barnes	TELEPHONE: 916-896-4593
	DATE: 03/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025

LIC809 (FAS) - (06/04)

Page: 5 of 5