444415939-6-18-2021-07-CC-EBEN-C44KL6-20210618075924

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444415939
Report Date: 06/17/2021
Date Signed: 06/18/2021 08:00:29 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:	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: 11	DATE:	06/17/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Lorena Vasquez		TIME COMPLETED:	02:00 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, Lorena Vasquez for a Required 1 year inspection. LPA explained the nature of today’s visit. Present during today’s visit were Licensee, Licensee's daughter, Jessica Vasquez, 15 year old daughter and 10 day care children and Licensee's 5 year old grandson and her 3 year old son. Licensee states there are two adults living in the home, 5 children; 17, 14, 10, and 3 years old. Days and hours of operation are Monday through Friday, 6:00 am to 6:00 pm. A review of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 06/17/2021 was reviewed and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPA inspected the indoor and outdoor areas of the home today. LPA inspected the indoor and outdoor areas. 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: 06/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

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: VASQUEZ, LORENA	FACILITY NUMBER: 444415939
	VISIT DATE: 06/17/2021

NARRATIVE

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LPA reminded licensee that she can only have 14 children according to her license. She understands her capacity options and ratio. Children were supervised during the visit and LPA went over substitute options. Licensee stated that she does not transport children. LPA reminded Licensee that children are not to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size. LPA reviewed facility roster and took a picture today of roster. LPA observed a fire and disaster drill log, last practiced drill was May 14, 2021. LPA reviewed 11 children’s files and observed a copy of the emergency information card (LIC 700) in each file. LPA observed that the Licensee has completed Mandated Reporter training. LPA reminded Licensee that course is to be renewed every two years. Licensee has current Pediatric CPR/1^st Aid expiring on 07/02/2022. Licensee has immunization's against pertussis, measles and influenza. Licensee has a TB in her file.
Incidental Medical Services (IMS) policy was discussed with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing IMS at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.
Licensee was reminded that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. LPA discussed the immediate civil penalties for Zero Tolerance of $500 and the Healthy Beverage Act and AB633 requirements for type A violation. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families.
Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.
An exit interview was conducted with Licensee in Spanish.
No deficiencies were cited during today’s inspection

Notice of site visit 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: 06/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

LIC809 (FAS) - (06/04)

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