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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
444412753
Report Date:
06/07/2022
Date Signed:
06/07/2022 02:02:44 PM
Document Has Been Signed on
06/07/2022 02:02 PM
- 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:
MANFRE, SANDY
FACILITY NUMBER:
444412753
ADMINISTRATOR:
MANFRE, SANDY
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(831) 724-2452
CITY:
WATSONVILLE
STATE:
CA
ZIP CODE:
95076
CAPACITY:
14
CENSUS:
13
DATE:
06/07/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
09:40 AM
MET WITH:
Sandy Manfre
TIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with
Licensee, Sandy Manfre
, for an unannounced Required- 1 Year Inspection. LPA was granted access to the home by the
Licensee
and toured both indoors and outdoors during the inspection. Upon arrival, there were
14
children
(10 preschool-age /3 infants /1 school-age)
, Licensee, and Assistant, Jessie Ausman,
present, which is not compliant with the home license capacity and ratio requirements. Facility is over ratio. LPA observed all required postings near the entrance to the home. Hours of operation for the facility are
Monday – Friday, 7:30AM-5:00PM
.
Licensee
states that adult
s,
over the age of 18, residing in the home are:
herself and her spouse (William Manfre)
. All adult
s
residing in the home have Criminal Background Check Clearance and signed Criminal Record Statements (LIC508).
Licensee
was reminded that all adults 18 and over living or working in the home, 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 reviewed facility roster (LIC9040) and fire/disaster drill log during todays inspection. The last fire/disaster drill was conducted on 4/3/2022
,
which is compliant with the six-month requirement for homes. LPA observed a fully charged
2A10BC
fire extinguisher, functioning smoke detector and carbon monoxide detector.
Licensee
states that she does not currently have any children in care who require Incidental Medical Services
and does not administer medication at this time
. The
Licensee
states that there are no weapons or firearms in the home.
SUPERVISOR'S NAME:
Joel Segura
TELEPHONE:
(408) 334-8550
LICENSING EVALUATOR NAME:
Cortney Nelson
TELEPHONE:
(916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE:
06/07/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/07/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
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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:
MANFRE, SANDY
FACILITY NUMBER:
444412753
VISIT DATE:
06/07/2022
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Family Child Care Homes, Section 102417. 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 toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at:
http://www.ada.gov/childqanda.htm
Ind
oor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Off-limits areas inside the home:
1 bedroom, master bedroom, and master bathroom. There is a fireplace located in the living room that requires proper barricade and screen.
LPA observed sufficient age-appropriate materials, toys, and play equipment in the home. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. Drinking water is readily available for children in the facility via
water dispenser and cups labeled with the children’s names.
The bathroom
in the home is clean, sanitary, and operable. Paper towels are provided for children to dry their hands. Diaper changing table is located in the laundry room next to the bathroom and equipped with a garbage with tight-fitting lid. The
Licensee
has a working telephone (cellphone/ land line) in the facility.
The backyard area of the home was inspected and LPA observed sufficient play-equipment and supplies for the children that are in good condition and age-appropriate. Off-limit areas outside of home include: 2
patios, deck, and lawn space beyond fenced area for children.
There are two sandboxes located outside for children to use that are covered. There is a waiver for fire pit and fountain at the family day care home. Fire pit is clean, covered, and not utilized during day care hours. Conditions of waiver for water fountain are not met, fountain needs to be refilled with rocks and emptied of all standing water. No additional outdoor bodies of water were observed during todays inspection.
LPA discussed the safe sleep regulations with
Licensee
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.
SUPERVISOR'S NAME:
Joel Segura
TELEPHONE:
(408) 334-8550
LICENSING EVALUATOR NAME:
Cortney Nelson
TELEPHONE:
(916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE:
06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/07/2022
LIC809
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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:
MANFRE, SANDY
FACILITY NUMBER:
444412753
VISIT DATE:
06/07/2022
NARRATIVE
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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.
13
children’s files were reviewed during todays inspection and most required documents were presen
t. LPA advised Licensee on additional document requirements for infants in care, such as Individual Infant Sleep Plan (LIC9227) and nap check documentation.
Licensee, Assistant, and Spouse files were reviewed and all required documents were present. Licensee has current CPR/First-Aid that expires
7/18/2022.
LPA advised Licensee on Mandated Reporter requirements commencing March 30 2018 for all staff working with children. Both Mandated Reporter and CPR/First-Aid must be renewed every 2 years.
Supervision of children was discussed with the
Licensee
and she understands that she must be home during day care hours and ensure that children are supervised at all times. The
Licensee
states that she
does not
transport any day care children. LPA reminded
Licensee
that children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.
Exit interview conducted and report was reviewed with the
Licensee, Sandy Manfre.
As a result of todays inspection, deficiencies were cited, see 809-D.
A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
To improve the quality and value of the new inspection process, a survey will be s
ent 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
.
SUPERVISOR'S NAME:
Joel Segura
TELEPHONE:
(408) 334-8550
LICENSING EVALUATOR NAME:
Cortney Nelson
TELEPHONE:
(916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE:
06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/07/2022
LIC809
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Page:
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Document Has Been Signed on
06/07/2022 02:02 PM
- 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:
MANFRE, SANDY
FACILITY NUMBER:
444412753
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/07/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above for non-screened fire place located in living room utilized by the day care, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/20/2022
Plan of Correction
1
2
3
4
Licensee will place screen in front of fire place to prevent access by children by 6/20/2022 and submit photo to Licensing. Screen will be maintained in front of fire place during operationing hours.
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, record review, and interview, the licensee did not comply with the section cited above for Licensee and assistant present, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/14/2022
Plan of Correction
1
2
3
4
Licensee will submit proof of completion of Mandated Reporter certificate (AB1207) by 6/14/2022 for herself and assistant, Jessie Ausman. Mandated Reporter training can be accessed at www.mandatedreporterca.com
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:
Joel Segura
TELEPHONE:
(408) 334-8550
LICENSING EVALUATOR NAME:
Cortney Nelson
TELEPHONE:
(916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE:
06/07/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/07/2022
LIC809
(FAS) - (06/04)
Page:
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Document Has Been Signed on
06/07/2022 02:02 PM
- 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:
MANFRE, SANDY
FACILITY NUMBER:
444412753
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/07/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, record review, and interview, the licensee did not comply with the section cited above for 4 out of 14 children present, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/10/2022
Plan of Correction
1
2
3
4
Licensee will submit emergency information card for children in care that do not have one by 6/10/2022.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for 3 out of 14 children present, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/10/2022
Plan of Correction
1
2
3
4
Licensee will submit proof of immunization record for all children missing documentation by 6/10/2022.
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:
Joel Segura
TELEPHONE:
(408) 334-8550
LICENSING EVALUATOR NAME:
Cortney Nelson
TELEPHONE:
(916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE:
06/07/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/07/2022
LIC809
(FAS) - (06/04)
Page:
5
of
9
Document Has Been Signed on
06/07/2022 02:02 PM
- 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:
MANFRE, SANDY
FACILITY NUMBER:
444412753
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/07/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above, roster is missing 3 children who were in present in care, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/10/2022
Plan of Correction
1
2
3
4
Licensee will submit updated childrens roster, including all children in care on roster with all fields completed by 6/10/2022.
Type B
Section Cited
CCR
102421(d)
102421 Child's Records (d) In any case in which the licensee cares for an additional child pursuant to... Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child's record, proof of parent notification that the facility is caring for an additional child as required in Section 102416.5(h).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for 14 out of 14 children present, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/10/2022
Plan of Correction
1
2
3
4
Licensee will provide Notification of Additional Child in Care (LIC9150) to all parents and submit signed documents by 6/10/2022.
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:
Joel Segura
TELEPHONE:
(408) 334-8550
LICENSING EVALUATOR NAME:
Cortney Nelson
TELEPHONE:
(916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE:
06/07/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/07/2022
LIC809
(FAS) - (06/04)
Page:
6
of
9
Document Has Been Signed on
06/07/2022 02:02 PM
- 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:
MANFRE, SANDY
FACILITY NUMBER:
444412753
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/07/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for 5 out of 14 children present, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/10/2022
Plan of Correction
1
2
3
4
Licensee will submit signed LIC995A for children missing documentation by 6/10/2022.
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:
Joel Segura
TELEPHONE:
(408) 334-8550
LICENSING EVALUATOR NAME:
Cortney Nelson
TELEPHONE:
(916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE:
06/07/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/07/2022
LIC809
(FAS) - (06/04)
Page:
7
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Document Has Been Signed on
06/07/2022 02:02 PM
- 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:
MANFRE, SANDY
FACILITY NUMBER:
444412753
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/07/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.5(g)
Staffing Ratio and Capacity
(g) For the purpose of meeting the criteria in Sections 1597.44 and 1597.465 of the Health and Safety Code, for a school age child who is under age six, the licensee shall maintain documentation verifying the
child’s enrollment and attendance at kindergarten, including transitional kindergarten, or elementary
school.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for 1 out of 14 children present, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/10/2022
Plan of Correction
1
2
3
4
Licensee will submit documentation verifying the childs enrollment and attendance at transitional kindergarten by 6/10/2022. Documentation will be maintained in children's file.
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.
SUPERVISOR'S NAME:
Joel Segura
TELEPHONE:
(408) 334-8550
LICENSING EVALUATOR NAME:
Cortney Nelson
TELEPHONE:
(916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE:
06/07/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/07/2022
LIC809
(FAS) - (06/04)
Page:
8
of
9
Document Has Been Signed on
06/07/2022 02:02 PM
- 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:
MANFRE, SANDY
FACILITY NUMBER:
444412753
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/07/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)(2)
102416.5 Child's Records (d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10 shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above, present at the home were 10 preschool age, 3 infants, and 1 school-age, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
06/08/2022
Plan of Correction
1
2
3
4
Licensee will submit updated weekly schedule for children attending the facility. Licensee will not allow more than 9 preschool-age children, 3 infants, and 2 school-aged children at one time.
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.
SUPERVISOR'S NAME:
Joel Segura
TELEPHONE:
(408) 334-8550
LICENSING EVALUATOR NAME:
Cortney Nelson
TELEPHONE:
(916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE:
06/07/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/07/2022
LIC809
(FAS) - (06/04)
Page:
9
of
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