444412982-11-17-2020-07-CC-EBEN-BVFP9C-20201117100651

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444412982
Report Date: 11/12/2020
Date Signed: 11/17/2020 10:06:56 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, OLGA		FACILITY NUMBER:	444412982
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	11/12/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	02:04 PM
MET WITH:	Olga Fernandez		TIME COMPLETED:	03:15 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 conducted an announced increase in capacity inspection via face time due to Covid-19. LPA met with Licensee Olga Fernandez. One day care child and Licensee's 12 year old son were present during the inspection. Olga and her adult son are the only adults living in the home. The last review of staff records was conducted on 11/12/2020 indicates that all individuals are cleared. 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. Days and hours of operation will be from Monday to Friday from 6:00 AM to 6:00 PM. Licensee has current CPR & First Aid, expiring January 30, 2021. Licensee showed LPA the home. Home appears clean, safe and orderly. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, Olga identified the off limit area as just a bedroom. Olga has central heat and air in the home. Olga understands that the off limit room must remain inaccessible to all day-care children. The home is equipped with a 3A40BC fire extinguisher, a working smoke and carbon monoxide detectors. Olga stated that there are no weapons in the home and she does not have any pets. Off limit areas in the backyard are the fenced side area to the right of the backyard and a locked shed. LPA observed that there is a stairway that leads to the backyard; the stairs in yard are barricaded. Cleaning Products, toxic agents, medications and sharp objects are inaccessible to children and Olga understands that items labeled with "keep out of reach of children" must be made inaccessible to children. LPA reminded Olga that poisons are to be locked. LPA reminded Olga that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. LPA reviewed roster and fire disaster drill log during today. Last practiced fire drill was 11/10/20.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2020

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, OLGA	FACILITY NUMBER: 444412982
	VISIT DATE: 11/12/2020

NARRATIVE

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LPA explained the ratio/capacity for a large family child care home to Licensee. Licensee stated that she does not transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats. Licensee has all needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing.

LPA discussed the immediate civil penalties for Zero Tolerance. 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 emailed a copy of the “Lead Poisoning Facts Information Flyer” to the facility. Safe sleep was discussed with the Licensee and Guide to Safe Sleep information was emailed to the licensee. Department website: http://ccld.ca.gov provided to Licensee.

An exit interview was conducted with Licensee in Spanish. LPA informed Licensee that this report and notice of site visit will be emailed to her. Licensee understands that in lieu of a signature, a read receipt or confirmation of receiving the report email must be submitted within 24 hours. Licensee's email address is osalgado1364@gmail.com

No deficiencies cited during today. Notice of site visit must remain posted for 30 days. A Large License (capacity 14) is approved today.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2020

LIC809 (FAS) - (06/04)

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