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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274416528
Report Date: 09/14/2022
Date Signed: 09/14/2022 04:50:34 PM

Document Has Been Signed on 09/14/2022 04:50 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:PERALTA ALBERTO, IRENEFACILITY NUMBER:
274416528
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
09/14/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Irene Peralta Alberto TIME COMPLETED:
05:00 PM
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Licensing Program Analysts (LPA) Elizabeth Larios conducted a unannounced inspection in response to Licensee's request for a change of location application received by the Department. LPA met with Licensee, Irene and explained the purpose of today's inspection. LPA note that Licensee was licensed at 71 Navajo Drive Salinas, CA 93906 (Facility number: 274415612).

Application/Record Review: Licensee was the only one present in the home. The adults that reside in the home are Licensee's spouse. Licensee's two minor children also live in the home. Licensee resides in a one story house, three-bedroom and two-bathroom house. Days and hours of operation will be Monday to Saturday 4:00 AM to 3:00 AM. Licensee's CPR and First Aid certification is current, with an expiration date of June 4, 2024. Licensee's Mandated Reporter Training for Child Care Workers expires on July 7, 2024. The Licensee rents the home and Property Owner/Landlord Notification (LIC 9149) form is in file and leasing agreement. All individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances prior to today's inspection.

Physical Plant tour: There is a working telephone in the home (831) 585-6026. The home is clean and has heating and ventilation for safety and comfort. LPA observed that there's a fireplace that is barricaded in the living room. The off limit areas inside the home: master bedroom/bathroom, bedrooms # 1 & 3, and garage. Off limit areas outside the home: one locked storage shed in the left side of yard and the left side of house. There are safe and age appropriate toys, play equipment, and materials for the children in the home. The licensee has a designated area in the home where a child(ren) can be isolated if exhibiting signs of illness. The home has working smoke/carbon monoxide detectors.

Continuation on next pages:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2022
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: PERALTA ALBERTO, IRENE
FACILITY NUMBER: 274416528
VISIT DATE: 09/14/2022
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Physical Plant tour (cont.): Licensee has one fire extinguisher (3A40BC) in the home that are fully charged in the kitchen area. Licensee stated that there are weapons, LPA observed weapon locked. LPA did not observe ammunition locked and stored separately.
All cleaning compounds, sharp objects, medications, and other similar items are stored inaccessible to the children. There are no poisons inside the home. Licensee understands that baby walkers, baby bouncers, jumpers, and saucer chairs are not allowed in the home. Licensee states that no one in the home smokes and she understands that smoking is prohibited in the home. Licensee has a first aid kit in the home, which also has a thermometer and sufficient emergency supplies. There were no bodies of water observed.

Kitchen tour: The refrigerator and freezer in the home is clean. Licensee understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated.

Bathroom tour: The toilet and faucet are clean, safe, and operable. The bathtub and shower are free of any hazards. Sharp objects and cleaning products are stored inaccessible to children.

Document/Regulation Review: A Family Child Care Home packet with updated Licensing forms was provided to Applicant. Documents from the packet, including but not limited to the following were discussed and reviewed with the Applicant: 1) Child Care Facility Roster (LIC 9140) must be complete and current at all times, 2) Fire/disaster drills must be practiced at least once every 6 months and documented on the fire/disaster drill log provided to the Applicant, 3) Posting requirements - Parent's Rights (PUB 394), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), and Facility License, 4) Staffing & Ratio - capacity/ratio limitations handout, 5) Safe Sleep Regulations (PIN 20-24-CCP), 6) Lead Flyer Requirement (PIN 20-01-CCP), and 7) Forms and Records to keep in your Family Child Care Home (LIC 311D).

Licensee states that she will talk to the children and use redirection as forms of discipline. Licensee understands that children's personal rights should not be violated; including no corporal punishment, supervision of children, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed with the Licensee.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
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: PERALTA ALBERTO, IRENE
FACILITY NUMBER: 274416528
VISIT DATE: 09/14/2022
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Incidental Medical Services (IMS) policy was discussed with the Licensee. 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. Licensee states that she does not plan on administering medication to the day care children at this time.

Notification requirements/civil penalty: LPA discussed the requirements of AB 633 with the Licensee. The Licensee understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations with the Licensee and advised her of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected. 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.

An exit interview was conducted with Licensee and was informed that upon approval of Licensing Management, a change of location would be granted to Licensee.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
LIC809 (FAS) - (06/04)
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