444412982-12-16-2021-07-CC-EBEN-C9QT56-20211215132502

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444412982
Report Date: 12/15/2021
Date Signed: 12/16/2021 08:25:24 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:	FERNANDEZ, OLGA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 840-1364
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 4	DATE:	12/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Olga Fernandez		TIME COMPLETED:	01:30 PM

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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Olga Fernandez for an annual inspection and explained the reason for the visit to her. Present during today's visit were licensee and four day care children (4 preschoolers). Adults living in the home are licensee, her adult son (Ronaldo Garcia) and 13 year old son.

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 12/15/21 was reviewed and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. 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 inspected inside and outside of the home. 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, 2023 Home is clean, orderly and safe for children. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside the home is one bedroom (adult's son room) and bathroom. Licensee uses the bathroom in her bedroom for day care children. There is a gate barricading the entrance to off limit bathroom and bedroom. The laundry room is off limits; door is closed and locked today. 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. LPA observed a 3A40BC fire extinguisher. The smoke and carbon monoxide detectors were tested and proved to be functioning. Olga stated that there are no weapons in the home. Licensee stated they do not transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.

Continues on report dated 12/15/2021

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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: FERNANDEZ, OLGA	FACILITY NUMBER: 444412982
	VISIT DATE: 12/15/2021

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LPA reviewed a current Child Care Facility Roster during today's inspection. Licensee has liability insurance for the day through DCI insurance. Licensee has current CPR and First Aid certifications (expiration: 01/29/2023). Licensee has the required vaccines (MMR, Tdap, & flu shot document has her name as Olga Salgado) and is current with the Mandated Reporter Training for Child Care Workers (expiration: 01/15/2022). LPA reviewed staff file (Licensee), file was complete.
LPA observed a fire disaster drill log, last practiced drill was 12/2/2021.
LPA observed that Olga added a door to laundry room area. Olga also removed a wall to expand her kitchen (open concept).

LPA discussed the safe sleep regulations with the 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. LPA also informed the 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.

To improve the quality and value of the new inspection process, a survey will 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 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

Exit interview conducted and report was reviewed with the Licensee, Olga Fernandez.

No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC809 (FAS) - (06/04)

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