444415939-7-2-2020-07-CC-EBEN-BR5T97-20200702143124

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444415939
Report Date: 07/01/2020
Date Signed: 07/02/2020 02:31:34 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:	VASQUEZ, LORENA		FACILITY NUMBER:	444415939
ADMINISTRATOR:	LORENA VASQUEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 247-8372
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS:	DATE:	07/01/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Lorena Vasquez		TIME COMPLETED:	10:00 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 Analyst (LPA) Elizabeth Berumen conducted an announced pre licensing tele-inspection via video conference call (Face Time) with Lorena Vasquez as a result of Covid -19 related restrictions. LPA met with Applicant, Lorena Vasquez and explained the nature of today's inspection. Lorena states she is the only adult living in the home. Lorena has 5 children who live in the home. Ages 17, 15, 12, 9 and a 1 year. All Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Lorena Vasquez of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Days and hours of operation will be Monday to Friday 6:00 am to 6:00 pm. CPR and First Aid certification expired June 2020. Lorena is scheduled to renew the CPR & First Aid course tomorrow, July 2, 2020. Lorena understands the requirement of keeping a current roster and practicing fire disaster drills and document drills once every six months. LPA inspected the indoor and outdoor areas during video conference call. There are no stairs inside the home. Three bedrooms, kitchen and laundry room are off limits to children. There is a gate between kitchen and dining room area to prevent children from accessing the kitchen area. There is a gate barricading the laundry room area to prevent children from accessing that area. LPA observed a fully charged 3A40BC fire extinguisher. The smoke detector and carbon monoxide detector were tested and proved to be functioning. LPA observed a fenced backyard, and no bodies of water. The storage shed in the backyard is locked and off limits to children. The left and right sides of the backyard is off limits and gated to prevent children from entering.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2020

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: VASQUEZ, LORENA	FACILITY NUMBER: 444415939
	VISIT DATE: 07/01/2020

NARRATIVE

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Lorena states that there are no weapons in the home. Cleaning Products, toxic agents, medications, and sharp objects are inaccessible to children. LPA reminded Lorena that poisons are to be locked. Lorena has a locked cabinet. LPA reminded Lorena that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. Lorena completed the Mandated Reporter Training on November 19, 2018 and understands it is to be renewed every two years. Website for training is mandatedreporterca.com

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. Currently Lorena has a sign in and out sheet outside of her home due to covid-19, she has hand sanitizer and postings are posted throughout the facility.

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. 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 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 emailed to Lorenaa9222@yahoo.com - A read receipt is requested to serve as Applicant's signature.
A provisional license is approved today. Applicant is to complete CPR & First Aid training.
A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2020

LIC809 (FAS) - (06/04)

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