444416000-6-1-2021-07-CC-EBEN-C3L5NZ-20210601200708

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444416000
Report Date: 05/14/2021
Date Signed: 06/01/2021 08:07:50 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:	CALDERON, KARINA		FACILITY NUMBER:	444416000
ADMINISTRATOR:	KARINA CALDERON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 539-3551
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 2	DATE:	05/14/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Karina Calderon		TIME COMPLETED:	05:00 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 conducted a scheduled Tele Pre-Licensing inspection via video conference call (FaceTime) with Licensee, Karina Calderon and explained the nature of today's inspection re: change of location request. The Licensee is currently licensed at 15 Shady Oaks Drive Watsonville CA 95076 (Facility 444412966). There is a total of 9 adults living in the home Fernando, Marisol, Florinda, Ramiro, Gabriel, Yareli, Isreal, Elvia, and Licensee, Karina. There are 4 minor children who live in the home; one is 17 years old. LPA reminded Karina that when child turns 18 she requires fingerprint clearances, tb test and criminal record statement. Days and hours of operation will be Monday to Friday from 6:00 AM to 6:00 PM. Licensee has current CPR and First Aid certifications expiring 02/26/2023. Licensee rents the home and has consent from the landlord. Licensee completed the Mandated Reporter Training and understands that the training must be renewed every two years. Licensee is in process of transferring her day care insurance from her previous license to this license. Licensee showed LPA Berumen the indoor and outdoor areas of the home. The off limit areas in the home are 3 bedrooms and 3 hall closets. The home has a separate living area (2 bedrooms, kitchen and bathroom). Licensee's mother lives in that area and is off limits to day care children. The bathroom cabinet has a lock. LPA observed two barricaded wall heaters. The kitchen is off limits; all cabinets have magnetic locks. There is a baby gate to prevent children from entering the kitchen. Licensee is using the living room as day care area. Licensee states there are no weapons in the home. There is a pet dog that is kept outside in off limit area. There is a fenced off portion of the backyard that is off limits to children; there is nopales and plants in that area. The entire backyard is fenced. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 05/14/2021):

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021

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: CALDERON, KARINA	FACILITY NUMBER: 444416000
	VISIT DATE: 05/14/2021

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 05/14/2021):

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors and no bodies of water.
LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. LPA reminded Licensee that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. LPA also reminded Licensee that any poisons are to be locked.
A review of staff records on May 14, 2020 indicates that NOT all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded the Licensee 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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
Forms of discipline used by Licensee: talk to children. The Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options (includes minor children living in the home under 10 years of age), transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA reminded Licensee that fire/disaster drills must be practiced at least once every 6 months and documented.
LPA received an approved fire clearance from the Watsonville Fire Department on 05/09/2021 prior to today's inspection.

LPA conducted an exit interview with the Licensee and advised her that before A large license can be approved the following is required:
1. Fingerprint clearances for NAMBOESCUTIA, RAMIRO and
CALDERONABREGO FERNANDO

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021

LIC809 (FAS) - (06/04)

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