<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415534
Report Date: 03/25/2022
Date Signed: 03/25/2022 01:44:21 PM

Document Has Been Signed on 03/25/2022 01:44 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:ROCHA, MONICAFACILITY NUMBER:
274415534
ADMINISTRATOR:ROCHA, MONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 254-5165
CITY:CASTROVILLESTATE: CAZIP CODE:
95012
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 6DATE:
03/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Monica RochaTIME COMPLETED:
01:55 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) Fermin Campos-Jaramillo conducted an unannounced annual inspection to the home today. LPA met with licensee's helper Maria V, licensee Monica arrived 20 minutes later. LPA explained the nature of today's inspection to the helper.. Days and hours of operation are Monday to Saturday from 5:30 AM to 6:00 PM. The adults that reside in the home are the Licensee, her spouse Nicanor (present today), her daughter in law and helper Maria V (present) and her son Michael. There were 6 children in care today included one infant and five preschool age, included licensee's 3 years old child. Licensee's minor children ages 17 and 14, and 3 years old reside in the home. Licensee's certifications for CPR and First Aid card is current and will expire on 9/6/22 and for helper 3/25/23.
LPA toured the indoor and outdoor areas of the home during today's inspection. LPA reviewed the Child Care Facility Roster during today's inspection and it is current. LPA reviewed 12 children's files and they are complete and current including the parent's rights form, and the immunization records form. Licensee has documented a fire drill during the last six months. Last fire drill was documented on 3/10/22.
The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: Three bedrooms, the kitchen, one bathroom and the attached garage. LPA observed there are no stairs in the home. Off limits areas outside: The back yard. LPA observed the back yard is fenced. Licensee uses the left side yard as playground whenever the weather allows it. LPA observed a fully charged 3A40BC fire extinguisher last serviced on 8/16/21 and working smoke detectors. LPA observed the home has a working carbon monoxide detector and no bodies of water. LPA observed there are not wall heaters or a fireplace in the home. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. LPA discussed Incidental Medical Services (IMS) with the Licensee.
Licensee has in file proof of immunization for herself and for her helper Maria V according with the SB792 for measles, pertussis and influenza.

**********************************Report dated 03/25/22 continues in page 2.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: ROCHA, MONICA
FACILITY NUMBER: 274415534
VISIT DATE: 03/25/2022
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
26
27
28
29
30
31
32
Report dated 03/25/22 continues from page 1.
Supervision of children was discussed with the 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. The Licensee understands her capacity options and she understands she cannot have more than 14 children in the home at any time and must observe ratio (age of the children). Licensee understands that her own 3 years old child count as part of the capacity of her license until he reaches the age of 10 years old. Licensee understands that a helper is required to assist in the home whenever the number of children is greater than 8. . The Licensee states that she does not transport children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time. Licensee uses redirection and communication with children as a form of discipline.
Department website: www.ccld.ca.gov provided to Licensee.
LPA discussed the requirements of AB 633 whenever a Type A deficiency is cited. LPA also discussed "zero tolerance" related regulations with the Licensee.
LPA observed that the Licensee has completed on 8/03/20 and her helper Maria V on 1/21/22 the required "mandated reporter" training that all Licensees and adults in contact with children will be required to complete starting January 1, 2018. Licensee understands that training must be renewed every two years. LPA referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training. A review of staff records on 3/22/22 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee Monica Rocha 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 discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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.

Report dated 3/25/22 continues on page 3.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: ROCHA, MONICA
FACILITY NUMBER: 274415534
VISIT DATE: 03/25/2022
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
26
27
28
29
30
31
32
Report dated 3/25/22 continuers from page 2.

Incidental Medical services (IMS) policy was discussed. 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 (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: http://www.ada.gov/childqanda.htm

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 the licensee Monica Rocha.

No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3