444413003-5-14-2019-07-CC-EBEN-BC6LEU-20190514084208

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444413003
Report Date: 05/13/2019
Date Signed: 05/14/2019 08:42:13 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:	ANAYA, TERESA		FACILITY NUMBER:	444413003
ADMINISTRATOR:	ANAYA, TERESA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 786-6007
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 12	DATE:	05/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:47 PM
MET WITH:	Teresa Anaya		TIME COMPLETED:	01:45 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	Licensing Program Analyst's (LPA) Elizabeth Berumen conducted an annual random inspection. LPA met with Licensee, Teresa Anaya and explained the nature of today's inspection to her. LPA observed Licensee's helper, Maria Anaya Rocha and 12 day care children in the home during the visit; 2 infants and 10 pre-school children; 11 of the 12 children were observed napping. The adults that reside in the home are Licensee, her sister, brother in-law and her adult niece. Teresa's 14 year old nephew lives in the home. Day-care hours are from Monday - Friday from 6:00 AM to 6:00 PM. LPA inspected the on limit areas of the home. Teresa identified the following as off limit areas: 3 bedrooms, hall closets and lower deck of the backyard. Outdoor play area is fenced. Teresa has a working cell phone number. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean and orderly. LPA observed a fully charged 2A10BC fire extinguisher. LPA observed a smoke detector and carbon monoxide detector. No bodies of water were observed. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children are stored where they are inaccessible to children. Licensee states there are no weapons in the home. LPA reviewed and obtained a copy of children roster. Fire disaster drill log was reviewed; last practiced drill was July 10, 2018. LPA notes that Teresa works from May - November of each year and closes her day care the rest of the months. She states she practices fire drills every month from May to November. Supervision of children was discussed with Teresa 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 with a qualified assistant present. The Licensee states that she does transport children via vehicle; however, she understands that children cannot be left in parked vehicles unattended at any time. (report dated May 13, 2019 continues on following page)

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019

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: ANAYA, TERESA	FACILITY NUMBER: 444413003
	VISIT DATE: 05/13/2019

NARRATIVE

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LPA reviewed children files.
LPA reviewed Licensee's Teresa Anaya's file- Teresa Anaya completed the Mandated Reporter Training on 02/07/2018. Teresa has current CPR & First Aid Certification, expiring on 03/3/20. Teresa has immunization against pertussis, measles and declined influenza vaccine; signed declaration dated 09/19/18 was reviewed.
LPA reviewed licensee's assistants file; Maria Anaya Rocha- she completed the mandated reporter training on 03/26/18. Maria Anaya Rocha has current CPR & First Aid expiring on, 03/3/20. Maria has tb test, immunization against pertussis, measles and declined the influenza vaccine.

LPA discussed Lead Safety Information (AB 2370). Chapter 676, statues of 2018, requires all child care providers, upon enrolling or re-enrolling any child, to provide the parent or guardian with written information. website www.ccld.ca.gov was provided; Licensee can access the Effects of Lead exposure flyer to handout to parents.

Safe Sleep was discussed: place infants on their backs when sleeping, use a firm sleep surface such as a mattress in a safety approved crib, keep soft bedding such as blankets, pillows, toys out baby's sleep area and ensure that pacifiers have nothing attached to them. LPA provided Licensee SIDS handouts.

LPA discussed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, etc.

An exit interview was conducted with Licensee in Spanish. No deficiency cited. A copy of this report was provided to Teresa Anaya at the conclusion of the inspection.
NOTICE OF SITE VISIT WAS ISSUED AND MUST BE 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: 05/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019

LIC809 (FAS) - (06/04)

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