444415704-9-10-2021-07-CC-KGOL-C6QVK6-20210910162948

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444415704
Report Date: 09/10/2021
Date Signed: 09/10/2021 04:29:57 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:	PINEDA, GRISELDA		FACILITY NUMBER:	444415704
ADMINISTRATOR:	PINEDA, GRISELDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 331-1797
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95060
CAPACITY:	14	CENSUS: 7	DATE:	09/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Griselda Pineda		TIME COMPLETED:	04:30 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) Goodell met with licensee, Griselda Pineda, for the purpose of an Unannounced Annual Random Inspection. Hours of operation are Monday- Friday, 8:30am- 5:00pm. During inspection LPA, observed 2 child napping in daycare room located downstairs. LPA observed also observed 6 children present with assistant in the outdoor area. All individuals subject to criminal background review have obtained a criminal record clearance. Licensee acknowledge any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday must be reported to the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). Inspection was conducted in all areas accessible to children. Off-limits areas include includes the entire upstairs: 1 restroom, 3 bedrooms, storage room, downstairs: that has kitchen, bathroom (next to kitchen), bedroom (next to kitchen) and outdoor: garage and studio. LPA observed napping room located downstairs in on limits bedroom and yurt located in backyard. LPA verified phone number and email are current. LPA also observed a 3A40BC fire extinguisher, smoke and carbon monoxide detectors. No weapons or bodies of water located in the home. LPA observed cleaning compounds, medication and knives are stored inaccessible to children. LPA observed outdoor area is fenced however LPA observed a loose fence board with nails exposed which poses a potential risk to children in care. Licensee stated proof of board closed and repaired will be submitted by POC due date. Licensee acknowledged that 100% supervision is required in unfenced area. LPA also observed fire drill log and children roster maintained. Report continues on LIC809-C

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

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: PINEDA, GRISELDA	FACILITY NUMBER: 444415704
	VISIT DATE: 09/10/2021

NARRATIVE

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Staff files were also reviewed. LPA observed proof of mandated reporter training were not on file which poses a potential risk to children in care. The Mandated Reporter Training was discussed. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. In addition, effective January 1, 2018: Applicants must meet requirements as a precondition to licensure, existing licensees must meet requirements by March 30, 2018, new employees shall have 90 days from date of employment to complete training as required. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. Licensee acknowledged requirement and stated proof will be submitted to LPA by POC due date. Preventative health training, current pediatric CPR and first aid certification was verified and expires 9/20/2021. Licensee acknowledged where children less than five years old are in care, stairs shall be fenced or barricaded. The Effects of Lead Exposure brochure posted. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, forms, self-assessment guides, legislation and regulation information. PIN 21-08-CCP and COVID-19 UPDATE Guidance: Child Care Programs and Providers were discussed. 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 (USDOJ) 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

Deficiencies cited on LIC809-D. LPA reviewed report with the licensee and provided copies. An exist interview was conducted. The Notice of Site Visit issued and must remain posted for 30 days. Appeal Rights also issued and discussed.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: PINEDA, GRISELDA	FACILITY NUMBER: 444415704
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/10/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/17/2021 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to. This requirement is not met due to LPA observed loose fence board with exposed nails in outdoor area which poses a potential risk to children in care.
Type B 10/08/2021 Section Cited	1 2 3 4 5 6 7	On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated
	8 9 10 11 12 13 14	reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met due to during staff file review proof of Mandated Reporter Training were not on file which poses a potential risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7

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: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

LIC809 (FAS) - (06/04)

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