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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444415565
Report Date: 08/15/2022
Date Signed: 08/15/2022 11:01:12 AM

Document Has Been Signed on 08/15/2022 11:01 AM - 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:PEREZ, MARTHAFACILITY NUMBER:
444415565
ADMINISTRATOR:PEREZ, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 227-4727
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 2DATE:
08/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Martha PerezTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Licensee, Martha Perez, for an unannounced Required- 1 Year Inspection. LPA was granted access to the home by the Licensee and toured both indoors and outdoors during the inspection. During today's inspection, there were 2 school-age children, Licensee, & Licensee's adult son and daughter present, which is compliant with the home license capacity and ratio requirements. LPA observed all required postings near the entrance to the home. Hours of operation for the facility are Monday – Friday, 6:00AM-6:00PM.

Licensee states that adults, over the age of 18, residing in the home are: herself, her son (Jesus), her daughter (Perla), and her mother (Hermelinda). All adults residing in the home have Criminal Background Check Clearance and signed Criminal Record Statements (LIC508).

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 reviewed facility roster (LIC9040) and fire/disaster drill log during todays inspection. The last fire/disaster drill was conducted on 7/7/2022, which is compliant with the six-month requirement for homes. LPA observed a fully charged 3A40BC fire extinguisher (last serviced: 4/2022), functioning smoke detector and carbon monoxide detector. Licensee states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. The Licensee states that there are no weapons or firearms in the home. Licensee has current liability insurance through DC Insurance Services, Inc that expires 1/25/2023.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2022
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: PEREZ, MARTHA
FACILITY NUMBER: 444415565
VISIT DATE: 08/15/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Family Child Care Homes, Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Indoor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Licensee does not currently care for any infants, however LPA observed crib available for infant napping if needed for care. Off-limits areas of the home (indoors): entire second floor (3 bedrooms & 1 bathroom) and attached garage. Stairs were observed to be properly barricaded to keep children safe. LPA advised Licensee that stairs only need to be barricaded if children under 5 years of age are in care. There are no open-faced heaters in the home. LPA observed sufficient age-appropriate materials, toys, and play equipment in the home. Drinking water is readily available for children in the facility via fridge water dispenser and plastic colored cups. All food is prepared and provided by the family child care home as part of the Community Bridges food program. The bathroom in the home is clean, sanitary, and operable. The Licensee has a working telephone in the facility.

The backyard area of the home was inspected and LPA observed sufficient play-equipment and supplies for the children. Backyard area was observed to be fenced in and located on the patio outside the home. Off-limit areas outside of home include: everything outside of fenced patio area. Licensee discussed with LPA today about future plans to modify backyard area for additional outdoor space for children. LPA advised Licensee on gate placement for stairs located outside and for Licensee to submit updated facility sketch (LIC999A) once outdoor space is ready for children to use. No outdoor bodies of water were observed during todays inspection.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022
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: PEREZ, MARTHA
FACILITY NUMBER: 444415565
VISIT DATE: 08/15/2022
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2 children’s files were reviewed during todays inspection and all required documents were present, including Notification of Additional Children in Care (LIC9150).

The licensee and home resident files were reviewed and most required documents were present. The Licensee has current CPR/First-Aid that expires 3/19/2023 and Mandated Reporter Training that expires on 6/13/2024. LPA reminded Licensee that both trainings must be renewed every 2 years. LPA additionally advised Licensee that all adults who are alone with children must be First-Aid/CPR certified, including those that are alone with children while transporting them.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The Licensee states that herself and her adult son transport day care children and LPA confirmed both have current drivers licenses that expire 8/5/2024 and 5/11/2025. Vehicle used to transport day care children was observed by LPA to be properly equipped with car/booster seats for children enrolled. LPA reminded Licensee that children should not be left unattended in parked vehicles and that car seats shall only be used for transportation, not be used for sleeping.

Exit interview conducted and report was reviewed with the Licensee, Martha Perez.

As a result of todays inspection, no deficiencies were cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022
LIC809 (FAS) - (06/04)
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