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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444412917
Report Date: 09/22/2021
Date Signed: 09/22/2021 05:35:13 PM

Document Has Been Signed on 09/22/2021 05:35 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:ROCHA, ESPERANZAFACILITY NUMBER:
444412917
ADMINISTRATOR:ROCHA, ESPERANZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 728-2758
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
09/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:52 PM
MET WITH:Esperanza RochaTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Esperanza Rocha for unannounced Required – 1 year annual inspection (KIT 2). LPA was granted access to the home by the Licensee. LPA also observed Licensee's daughter (Abigail Fernandez) in the home during today's inspection. Abigail Fernandez is Licensee's assistant and does not have a criminal clearance or association with the facility. Upon arrival LPA observed Abigail's boyfriend, Roberto Lee Buckman present; Robert does not have criminal record clearances. Licensee's mother (Jovita Rocha) and father (Nacanor Castillo) were present in backyard studio. Licensee states there are 7 adults living in the home. Licensee's 11 year old grandson lives in the back upstairs studio with his parents (Troy Albo and Mayra Fernandez Rocha).
The Licensee was operating within her capacity and ratio requirements. LPA observed the required postings in one of the bedrooms used for day care. LPA asked Esperanza to post in visible area for parents to see. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed and documented on March 4, 2021. LPA reminded Esperanza to practice fire drills once every 6 months. The Licensee has the required vaccinations (MMR, Tdap). Licensee states that she declines the influenza vaccine. LPA asked her to sing and date a declaration and place it in her file. Licensee completed the mandated reporter training on February 19, 2021 and understands she is to renew it every two years. Licensee's certificate for CPR and First Aid is valid and expires 01/30/2023.
Safe sleep update: LPA discussed the new “Safe Sleep” regulations with the Licensee and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensee. LPA reminded the Licensee that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.

LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. Licensee provided her cell phone (831) 740-9236. 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.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2021
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: ROCHA, ESPERANZA
FACILITY NUMBER: 444412917
VISIT DATE: 09/22/2021
NARRATIVE
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There is a waiver on file for an electric fire place. Off limit areas in the home are two bedroom; and bathroom in master bedroom. Two studios in the back are off limits to day care children. Left fenced are of the backyard are off limits.

LPA observed a fully charged 3A40BC fire extinguisher and working smoke/carbon monoxide detectors. The Licensee states that she has two pet dogs and no weapons in the home. Licensee has a small fountain in off limit area of the backyard. Licensee understands the regulation for bodies of water. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. LPA reminded Esperanza that any poisons are locked and inaccessible to the day care children. The Licensee states that she does not administer any medication to the day care children at this time.

A review of staff records on September 21, 2021 indicates that NOT all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
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 without two fully qualified adults present. The Licensee states that does not transport any day care children. The Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

LPA conducted an exit interview with the Licensee prior to the conclusion of today's inspection and advised her that no deficiencies issued during today's inspection. A copy of this report and a notice of site visit will be emailed to esperanzarocha67@yahoo.com

LICENSEE AGREES TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS IN A VISIBLE AREA.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/22/2021 05:35 PM - It Cannot Be Edited


Created By: Elizabeth Berumen On 09/22/2021 at 02:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ROCHA, ESPERANZA
FACILITY NUMBER: 444412917

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/23/2021
Section Cited
CCR
102370(d)

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CRIMINAL RECORD CLEARANCE All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
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Licensee to have Abigail Fernandez and Roberto Lee Buckman fingerprinted with Live Scan by Thursday September 23. Licensee to notify LPA when the they have been fingerprinted.
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This requirement was not met as evidenced by: Licensee's daughter/Assistant Abigail Fernandez does not have criminal record clearance or association to facilty. Robert Lee Buckman was present during inspection and does not have criminal record clearances. Civil penatly of $600.00 is being accessed today.
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Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

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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:Mary Segura
LICENSING EVALUATOR NAME:Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2021


LIC809 (FAS) - (06/04)
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