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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444414528
Report Date: 08/28/2019
Date Signed: 09/04/2019 09:06:29 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:LEON, LUCILAFACILITY NUMBER:
444414528
ADMINISTRATOR:LEON, LUCILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 406-7862
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 5DATE:
08/28/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:22 PM
MET WITH:Lucila Leon TIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Elizabeth Berumen and Susy Cervantes conducted an unannounced random inspection to the home today. LPA met with Licensee, Lucila Leon and her assistant Kimberly Leon and explained the nature of today's inspection to her. LPA observed 5 children in the home; 4 Preschoolers and one school age. Days and hours of operation are Monday - Friday from 7:00 AM to 6:00 PM. Licensee states she is the only adult living in the home with her 14 year old daughter. Licensee and Assistant have certifications for CPR and First Aid that are current. Licensee's CPR & First Aid expires on 01/25/2021 and Kimerly's expires on June 2020.

LPA inspected parts of the facility in which family day care services are being provided and areas which children have access. Off limit areas in the home are: laundry room, master bedroom, master bathroom, and garage.

No bodies of water were observed during today's inspection. Licensee stated that there are no firearms or other dangerous weapons in the home. LPAs observed detergents, cleaning compounds, medication, and other items which could pose a danger to children are stored and inaccessible to children in the off limits laundry room. Licensee understands that poisons are to be locked.

LPAs observed a screened and blocked off fireplace to prevent access by children.
A fully charged 3A40BC fire extinguisher, working smoke detector, and working carbon monoxide detector were observed by LPAs. The home is clean and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home.
The home provides safe toys, play equipment, and materials. Licensee understands that each child has safe, healthful and comfortable accommodations, furnishings, and equipment. The licensee is present in the home and ensures that children in care are supervised at all times. Licensee does transport children and understands that children are not to be left in parked vehicles. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in their absence.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: LEON, LUCILA
FACILITY NUMBER: 444414528
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2019
Section Cited

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Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
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This requirement was not met by: Child 1 does not have immunization records.This poses a potential health and safety risk for the children in care.
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Type B
09/04/2019
Section Cited

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. . . the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement was not met
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by: Child 1, 4, and 5 did not have form in file. This poses a potentialrisk to the health and safety risk for the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: LEON, LUCILA
FACILITY NUMBER: 444414528
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2019
Section Cited

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Operation of a Family Child Care Home- A file of affidavits signed by each parent with a child enrolled in the home shall be kept by the licensee if she does not carry day care liability insurance or a bond.
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This requirement was not met by: Child 1, 3, 4 and 5 did not have the form on file
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: LEON, LUCILA
FACILITY NUMBER: 444414528
VISIT DATE: 08/28/2019
NARRATIVE
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The licensee maintains capacity specified on the license and understands she is not to have more than 14 children at a time. Smoking is prohibited on the premises of a family child care home.
LPA reviewed a current facility roster and obtained a copy. The Licensee conducts fire and disaster drills at least once every six months, and documents the date and time of each drill. The last fire drill conducted was on June 5, 2019.
5 children's records reviewed today. Children files reviewed today contain the immunization's and maintains and updates records for children in care. LPAs observed that one child does not have immunization records on file, assistant informed LPAs that child is new and mom has not brought them. Licensee provides the child's parent or representative with a copy of the family child care home notification of parents rights.
Both Licensee and Assistant have taken the mandated reporter training, Licensee will need to renew the course this year, assistant will need to renew training on August 2021. Licensee and assistant have immunization against pertussis and measles. Both Licensee and assistant declined the influenza vaccine.

All individuals subject to a criminal record review have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home.


LPA reminded licensee that any authorized employee of the Department may enter and inspect any place providing personal care and services at anytime, with or without advance notice. Kimberly Leon's file was reviewed today and has all required documents. LPAs printed out earthquake preparedness checklist (LIC 9148) and reminded Licensee facilities should also have, and regularly review, the earthquake preparedness checklist alongside the disaster plan.
Incidental Medical Services were discussed with the licensee. Licensee states she does not provided Incidental medical services.

Effective January 1, 2019, AB 2370, Chapter 676, Statutes of 2018, requires all child care providers, upon enrolling or re-enrolling any child, to provide the parent or guardian with written information regarding lead. Effects of lead exposure fact sheet was provided to Licensee.

The following deficiencies were cited on following 809D pages:

NOTICE OF SITE VISIT WAS ISSUED AND SHALL BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4