274411547-4-5-2023-07-CC-SCES-CQLQRR-20230405122421

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274411547
Report Date: 04/05/2023
Date Signed: 04/05/2023 12:24:31 PM

Document Has Been Signed on 04/05/2023 12:24 PM - It Cannot Be Edited

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:	JIMENEZ, MARIA & LEYVA, ARTURO		FACILITY NUMBER:	274411547
ADMINISTRATOR:	MARIA & ARTURO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 578-5021
CITY:	SALINAS	STATE: CA	ZIP CODE:	93906
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 1	DATE:	04/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Maria Jimenez		TIME COMPLETED:	12:35 PM

NARRATIVE

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On 04/05/2023 at 09:00 AM, Licensing Program Analyst (LPA) Susy Cervantes met with licensee, Maria Jimenez, for an annual inspection and explained the reason for the visit to them. Present during today's visit were licensees with 1 preschool child. Adults living in the home are licensees, their daughter, son in law, and grandson with two children ages 4 and 1. Days and hours of operation are Monday through Saturday 11:00 PM to 10:00 PM.

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 03/27/2023 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. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA inspected inside and outside of the home. LPA observed no fireplace, a wall heater that is behind a gated off area, no stairs, and no bodies of water. Licensee stated there are no weapons. Licensee stated they have dogs and they are vaccinated. LPA observed a fully charged 3A40BC fire extinguisher. Dual carbon Monoxide and smoke detector was operable. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children and stored under the locked sink, top kitchen cabinet, and garage. Backyard is fenced. Off limit areas: four bedrooms, one bathroom, garage, shed, left and right side yards.

Children were supervised during the visit and LPA went over substitute options and reminded licensee they could only have 14 children according to their license. Licensee stated they do transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.

Continues on report dated 04/05/2023 pg. 1/2

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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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Document Has Been Signed on 04/05/2023 12:24 PM - It Cannot Be Edited

Created By: Susy Cervantes On 04/05/2023 at 11:49 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: JIMENEZ, MARIA & LEYVA, ARTURO	FACILITY NUMBER: 274411547
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in which Child 12 is missing their immunizations which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/19/2023
	Plan of Correction
1 2 3 4	Licensee will request immunizations from parents of Child 12 and will transcribe immunization to PM 286 (CDPH 286). Licensee will submit a copy of PM 286 to the San Jose Regional Office (SJRO) by clsoe of business on April 19, 2023.

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in which Child 06 is missing their 15 minute sleep log which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/19/2023
	Plan of Correction
1 2 3 4	Licensee will create a sleep log and will document Child 06's sleep onto the log. Licensee will submit two to three day's worth of documented sleep to SJRO by close of business on April 19, 2023.

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:

Mary Segura

LICENSING EVALUATOR NAME:

Susy Cervantes

LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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: JIMENEZ, MARIA & LEYVA, ARTURO	FACILITY NUMBER: 274411547
	VISIT DATE: 04/05/2023

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Continuation of report dated 04/05/2023 pg. 2/2

LPA took a picture of a current roster of the children. LPA observed a fire and disaster drill log that was last conducted on 01/12/23. LPA reviewed 14 children’s files and observed Child 06 is missing a 15 minute sleep log and Child 12 is missing their immunizations. LPA observed that the Licensees have Mandated Reporter training, training was completed on 05/13/22 and 05/15/22. Licensees have Pediatric CPR/1^st Aid expiring 03/15/24 and 08/30/24. Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is on file for licensees.

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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Type B deficiencies were cited during today's visit. Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made. Exit interview conducted and report was reviewed in Spanish with the licensee, Maria Jimenez. 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.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

LIC809 (FAS) - (06/04)

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