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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274404252
Report Date: 06/29/2026
Date Signed: 06/29/2026 11:50:03 AM

Document Has Been Signed on 06/29/2026 11:50 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ROCHA, JOSEFINAFACILITY NUMBER:
274404252
ADMINISTRATOR/
DIRECTOR:		ROCHA, JOSEFINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 786-0771
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 3DATE:
06/29/2026
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:17 AM
MET WITH:Josefina RochaTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 06/29/2026, Licensing Program Analysts (LPAs) Diana De Leon and Pedro Gutierrez met with licensee Josefina Rocha for an unannounced annual inspection. LPAs explained the reason for the visit. Present were licensee, licensee’s husband (S1) and three daycare children – two school age and one infant. Days and hours of operation are Monday to Friday, 6:00am to 6:00pm and Saturdays, 6:00am to 2:00pm. The adults that reside in the home are licensee, S1, and licensee’s adult grandson (S2).

A review of staff records on 06/29/2025 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. Licensee Josefina Rocha was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption prior to initial presence in a Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if the regulation is violated.

LPAs toured the indoor and outdoor areas during today's visit. LPAs observed two adult men (S3 and S4) with no fingerprint clearance in outdoor area of the home that is not accessible to children. LPAs did not observe a fireplace, wall heaters, nor bodies of water. Off-limit indoors: entire second floor (master bedroom/bath, five bedrooms, and one separate bathroom), dining room, kitchen, second living room, laundry room, and attached garage. LPAs observed a fully charged 3A40BC fire extinguisher, working combo smoke and carbon monoxide detector, and fenced backyard. Off-limit outdoors: storage in driveway, two detached garages, back side of the home that is fenced off, and right side of the property that includes the living unit observed. LPAs observed a minimum of two emergency exits cleared for use.
NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Diana De Leon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/29/2026 11:50 AM - It Cannot Be Edited


Created By: Diana De Leon On 06/29/2026 at 11:16 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ROCHA, JOSEFINA
FACILITY NUMBER: 274404252

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(k)
Criminal Record Clearance
(k) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees, volunteers that require fingerprinting and non-client adults residing in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above: LPAs observed two adult men (S3 and S4) with no fingerprint clearance in outdoor area of the home that is not accessible to children, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/30/2026
Plan of Correction
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Licensee will have all adults be fingerprint cleared before being allow on the property while children are in care. Licensee will submit a letter stating she understands the regulations for fingerprint clearance by plan of correction due date: 06/30/2026.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Mireya Flores
NAME OF LICENSING PROGRAM MANAGER:
Diana De Leon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2026


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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ROCHA, JOSEFINA
FACILITY NUMBER: 274404252
VISIT DATE: 06/29/2026
NARRATIVE
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Licensee states that there are no firearms/weapons in the home. There are no animals in the home. LPAs observed licensee have a current CPR and First Aid certification expiring 01/25/2027 and completed Mandated Reporter training on 04/04/2025.

LPAs observed a current roster of the children and a fire and disaster drill log which was last completed on 06/03/2026. LPAs reviewed three children's files and observed all forms are completed, children have current immunization records, and infants have their sleep logs. Licensee does have daycare insurance and LPAs verified current policy. LPAs discussed SB792 Immunization Requirements and observed licensee have immunization records on file. No IMS is administered by the facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.



Supervision of children was discussed with 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. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time. Licensee understands if she transports children via vehicle, children cannot be left in parked vehicles unattended at any time.

LPAs discussed the safe sleep regulations with Licensee Josefina Rocha and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPAs also informed licensee Josefina Rocha of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Diana De Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ROCHA, JOSEFINA
FACILITY NUMBER: 274404252
VISIT DATE: 06/29/2026
NARRATIVE
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Licensee Josefina Rocha was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding www.cdss.cs.gov/inforesources/community-care-licensing/inspection-process.

During the exit interview, the LICENSEE JOSEFINA ROCHA confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee Josefina Rocha. Appeal rights was handed to the licensee.

LPAs Diana De Leon and Pedro Gutierrez informed licensee Josefina Rocha that this report dated 06/29/2026 documents one Type A citation which shall be posted for 30 consecutive days as there are risks to the health, safety, or personal rights of children in care.

Also, LPAs Diana De Leon and Pedro Gutierrez informed the licensee Josefina Rocha to provide a copy of this licensing reported dated 06/29/2026 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child’s file for verification.

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.
NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Diana De Leon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
LIC809 (FAS) - (06/04)
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