444414436-9-2-2022-07-CC-EBEN-CHW2JZ-20220902172711

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444414436
Report Date: 09/01/2022
Date Signed: 09/02/2022 05:27:41 PM

Document Has Been Signed on 09/02/2022 05:27 PM - It Cannot Be Edited

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: 0	DATE:	09/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Eva Dolores Rodriguez		TIME COMPLETED:	03:00 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 met with Licensee, Eva Dolores Rodriguez for an unannounced Required – 1 year annual inspection. LPA was granted access to the home by the Licensee. Eva states there are 3 adults living in the home (Licensee, Yvette Garcia, Remi Rodriguez). LPA observed the required postings, including the facility license, in the home. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. LPA reviewed a current Child Care Facility Roster during today's inspection. Licensee last practiced fire drill on June 13, 2022. The Licensee has the required vaccine records (MMR, Tdap, & flu) and current Mandated Reporter Training for Child Care Workers certificate expiring 02/18/2024. The Licensee's CPR and First Aid certifications expire on 09/29/2022. LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children in the home. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters inside the home. Backyard is fenced. Fire place is screened and inaccessible to children. LPA observed a fully charged 3A40BC fire extinguisher, working smoke & carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee states that she does not have any weapons in the home. Licensee has a dog. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. All poisons are inaccessible to children. The Licensee states that she does not administer any medication to the day care children.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

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: 09/01/2022

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Licensee understands that poisons are to be locked. Licensee states that she currently does not administer medication; Licensee has an IMS plan on file. Licensee has a first aid kit in the home which includes a touch less thermometer. Licensee states no one in the home smokes.

Supervision of children was discussed with the Licensee 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. Licensee understands her capacity/ratio options and she understands that she cannot have more than 8 children present in the home. Licensee states that does not transport any day care children. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

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 discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep web page 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, Eva Rodriguez. No deficiencies issued during today's inspection.

Licensee's email address is Rodriguezeva995@gmail.com

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: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC809 (FAS) - (06/04)

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