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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274413159
Report Date: 04/25/2023
Date Signed: 05/30/2023 02:32:41 PM

Document Has Been Signed on 05/30/2023 02:32 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:NAVARRO, ANABEL & SOCORROFACILITY NUMBER:
274413159
ADMINISTRATOR:NAVARRO, ANABEL & SOCORROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 728-1613
CITY:ROYAL OAKSSTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
04/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:48 PM
MET WITH:Anabel & Socorro Navarro TIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA), Elizabeth Berumen conducted a Required - 1 Year Inspection. LPA met with Licensees Anabel and Socorro Navarro, and explained the nature of today's inspection to them. Also present in the home were 5 day care children (one infant and two preschoolers and 2 school age children) All required posted materials were posted. The day-care is open Monday thru Saturday from 6:00 AM to 6:00 PM. There are no active waivers or exceptions for this facility. The day-care has three living quarters- attached garage is rented to two adults (Maurilia Aguilar and Bulmaro Gudino Zuniga) two children (1 & 2 years old). There is a detached studio where Socorros daughter, Matilde Navarro and her daughter Gennesis Ramirez live and 3 minor children (11, 9, and 5).
Anabel, Socorro, Vicente Cano, Gustavo Garcia live in the main house and Anabels two minor children ages, 7 and 6.

Per Licensee, the adults that reside in the home are herself, her husband (Armando Zamudio), and her son (Zino Zamudio). Licensee states that she has a minor daughter age 13 who also lives in the home.
Gustavo Garcia and Matilde Navarro have pending fingerprint status and Bulmaro Gudino Zuniga is not associated with facility. LPA notes that on the fingerprint application LIC 9163, the facility number is incorrect-274413154 instead of 274413159. LPA reminded licensee 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 observed a current children's roster (LIC9040). Copy of children's roster was obtained during the inspection. The last Fire/disaster drill was conducted on. LPA observed a fully charged 3A40BC fire extinguisher, functioning smoke and carbon monoxide detectors. Licensee states that there are no weapons or firearms in the home.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2023
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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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: NAVARRO, ANABEL & SOCORRO
FACILITY NUMBER: 274413159
VISIT DATE: 04/25/2023
NARRATIVE
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Off limit areas in the home: three bedrooms, garage, guest house and storage room in the backyard. The backyard is fenced and safe for children. LPA notes that a fenced was constructed to enclose the play area in 2020. Fire inspection was conducted on 06/10/2020. LPA observed cleaning products, sharp objects, and other items that are dangerous to children were stored accessible to children; LPA observed cleaning products in children's bathroom in the closet and under the bathroom sink. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. The home has a working telephone which is (831) 728-1613; Licensee (Anabel Navarro) provided LPA with her cell phone number (831) 202-8112. No bodies of water were observed.

LPA reviewed 5 children’s files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700).

Children's Immunization Records (PM 286/CDPH 286) are missing.
LPA reviewed Licensees' files for the following records: Anabel has current Mandated Reporter Training expiring on 2/2/25. Socorro's mandated reporter training is expired. Both Licensee's have current CPR & First Aid 08/07/23. LPA reviewed the immunization records for Anabel and Socorro; they both have immunization against pertussis and measles.
Incidental Medical Services (IMS) policy was discussed. Licensee states that she is not planning to administer any medication at this time. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Family Child Care Homes, Section 102417. 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 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: http://www.ada.gov/childqanda.htm
Continuation on next page:

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

Exit interview conducted and report was reviewed with Licensee, Anabel Navarro.

As a result of today's inspection, deficiencies cited on following pages: For type A deficiencies cited: Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 05/30/2023 02:32 PM - It Cannot Be Edited


Created By: Elizabeth Berumen On 04/25/2023 at 03:24 PM
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: NAVARRO, ANABEL & SOCORRO
FACILITY NUMBER: 274413159

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above. LPA observed detergents, and cleaning products underneath the bathroom sink and bathroom closet which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2023
Plan of Correction
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Licensee's agree to install a lock on the closet door and on kitchen sink to ensure the items are inaccessible to children.
Type A
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above; LPA observed a 7 month old infant asleep in the crib with three blankets; two blankets were propped near child's face which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2023
Plan of Correction
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Licensee's immediately corrected and agree to submit a written statement stating the understand the new safe sleep regulation.
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:Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/30/2023 02:32 PM - It Cannot Be Edited


Created By: Elizabeth Berumen On 04/25/2023 at 03:24 PM
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: NAVARRO, ANABEL & SOCORRO
FACILITY NUMBER: 274413159

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above; Tenant, Bulmaro Gudino Zuniga is not associated with facility which poses an immediate health, safety or personal rights risk to persons in care.
Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.


POC Due Date: 04/25/2023
Plan of Correction
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Licensee, Anabel Navarro agrees to have Bulmaro Gudino Zuniga fingerprinted.
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.
SUPERVISOR'S NAME:Mary Segura
LICENSING EVALUATOR NAME:Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2023


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 05/30/2023 02:32 PM - It Cannot Be Edited


Created By: Elizabeth Berumen On 04/25/2023 at 03:24 PM
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: NAVARRO, ANABEL & SOCORRO
FACILITY NUMBER: 274413159

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above; Licensee, Socorro does not have current mandated reporter training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/09/2023
Plan of Correction
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Mandated Reporter training for Socorro will be completed and mailed to LPA by plan of correction date.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review the licensee did not comply with the section cited above; all children (five) present were missing immunization records which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/09/2023
Plan of Correction
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Copies of immunization records of five children will be sent to LPA Berumen and filed in each childs file.
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:Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2023


LIC809 (FAS) - (06/04)
Page: 8 of 8
Document Has Been Signed on 05/30/2023 02:32 PM - It Cannot Be Edited


Created By: Elizabeth Berumen On 04/25/2023 at 03:24 PM
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: NAVARRO, ANABEL & SOCORRO
FACILITY NUMBER: 274413159

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)(2)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above; Infant in care does not have the LIC9227 in file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/28/2023
Plan of Correction
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LIcensee's agree to submit a copy of completed LIC 9227 for child 1 (infant) and file original in child's file.
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.
SUPERVISOR'S NAME:Mary Segura
LICENSING EVALUATOR NAME:Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/30/2023 02:32 PM - It Cannot Be Edited


Created By: Elizabeth Berumen On 04/25/2023 at 03:45 PM
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: NAVARRO, ANABEL & SOCORRO
FACILITY NUMBER: 274413159

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102370(d)(1)
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) obtain a California clearnace or a criminal record exemption as required by the Department...

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above; Two adult residents (Gustavo Garica and Matilde Navarro) were fingerprinted but currently do not have clearance which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/01/2023
Plan of Correction
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Licensee agrees to have Gustavo Garcia and Matilde Navarro re-fingerprinted by plan of correction date.
Section Cited
Deficient Practice Statement
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3
4
POC Due Date:
Plan of Correction
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2
3
4
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:Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2023


LIC809 (FAS) - (06/04)
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