444414436-12-12-2019-07-CC-EBEN-BJSN48-20191212090732

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444414436
Report Date: 12/10/2019
Date Signed: 12/12/2019 09:07:53 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:	RODRIGUEZ, EVA DOLORES		FACILITY NUMBER:	444414436
ADMINISTRATOR:	RODRIGUEZ, EVA DOLORES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 761-9715
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 4	DATE:	12/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Eva Dolores Rodriguez		TIME COMPLETED:	11:45 AM

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 Analysts (LPA) Elizabeth Berumen conducted an unannounced random inspection to the home today. LPA met with Licensee, Eva Dolores Rodriguez and explained the nature of today's inspection to her. Present during the inspection were three preschool age children and one school age child. Day care hours of operation are Monday - Friday from 6:00 AM to 6:00 PM and on Saturdays from 6:00 AM to 4:00 PM. The adults that reside in the home are: Licensee, her husband, her mother and adult son. Eva's certifications for CPR and First Aid are current and expire on September 2020. LPA inspected the indoor and outdoor areas of the home during today's visit. Home is clean, orderly and safe for children. The garage is used by children to enter and exit the backyard. LPA reviewed the Child Care Facility Roster. LPA reviewed the Fire/Disaster drill log. Last practiced drill was 12/05/19. The Licensee has a working telephone in the home and provided her cell number, (831) 539-7769. LPA observed sufficient materials, toys, and play equipment for the day care children. LPA observed a covered fireplace in the living room/day care room. LPA observed a fully charged 3A40BC fire extinguisher. LPA tested the dual carbon monoxide and smoke detector today; it proved to be functioning. No bodies of water were observed. Eva states that there are no weapons in the home. Eva has a pet dog. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children are inaccessible to children. Eva has a locked cabinet in the garage where she stores poisons, chemicals etc.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019

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: RODRIGUEZ, EVA DOLORES	FACILITY NUMBER: 444414436
	VISIT DATE: 12/10/2019

NARRATIVE

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Supervision of children was discussed with Eva 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. Eva states that she does transport children in her vehicle when it rains; and she understands that children cannot be left in parked vehicles unattended at any time.

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. LPA provided Licensee with, 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 emailed Licensee link to access information.

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. A copy of this report was provided to the Licensee at the conclusion of the inspection.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

No deficiency cited.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019

LIC809 (FAS) - (06/04)

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