444413610-5-1-2019-07-CC-EBEN-BBRRHH-20190501130223

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444413610
Report Date: 05/01/2019
Date Signed: 05/01/2019 01:02:28 PM

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:	COVARRUBIAS, OLIVIA		FACILITY NUMBER:	444413610
ADMINISTRATOR:	COVARRUBIAS, OLIVIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 722-8086
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 6	DATE:	05/01/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Maria Gonzalez Vazquez and Illiana Rubi Covarrubias		TIME COMPLETED:	01:15 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 annual random inspection. LPA met with Licensee daughter in law, Maria Gonzalez Vazquez and daughter, Illiana Rubi Covarrubias Calvario and explained the nature of today's inspection Maria states that Licensee, Olivia is out of the home for an appointment. Also present in the home were 6 day care children, and two assistants, Montsevrat and Maria Gonzalez. All six children present during inspection are preschool age. Days and hours of operation are Monday through Friday from 6:00 AM to 6:00 PM. There are 5 adults living in the home. A review of staff records during today's visit indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA inspected the on limit areas of the facility. Off limit areas in the home are 3 bedrooms, hall way closet, closet in living room and laundry closet. All off limit bedrooms are closed and have a latch on top of door to prevent children from accessing the area. The kitchen is off limits; there is a gate to prevent access. The backyard is fenced. LPA observed a fully charged 3A40BC fire extinguisher which meets Fire Marshall standards, working smoke detector, working carbon monoxide detector, and no bodies of water. Cleaning products, detergents, medications, sharp objects, and other similar items are stored inaccessible and poisons are locked. LPA observed cleaners stored on top of the refrigerator inaccessible to children. LPA reviewed a current children's roster. Fire disaster drill log was reviewed, last practiced fire drill was 04/11/19 and earthquake drill was practiced on 04/24/19. The home has a working telephone which is (831) 722-8086. LPA reviewed six children files; all contain required documentation. Licensee has day care insurance. Required postings; Facility License, parents rights, emergency disaster plan and earthquake preparedness checklist were posted.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019

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: COVARRUBIAS, OLIVIA	FACILITY NUMBER: 444413610
	VISIT DATE: 05/01/2019

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Licensee has current CPR and First Aid certifications with an expiration date of 05/2020. Licensee's daughter (Illiana Rubi Covarrubias) who is present today has current CPR & First Aid, expiring on 08/2019. Licensee completed mandated reporter, AB1207 compliant on 10/29/17. Licensee understands the course it to be renewed every two years.

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 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.

Exit Interview was conducted with Licensee's daughter, Illiana Rubi. This report was translated in Spanish. No deficiency cited. A copy of this report was provided to Illiana Rubi 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: 05/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019

LIC809 (FAS) - (06/04)

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