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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417512
Report Date: 08/14/2025
Date Signed: 08/14/2025 01:31:40 PM

Document Has Been Signed on 08/14/2025 01:31 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:FERNANDEZ, MARIAFACILITY NUMBER:
274417512
ADMINISTRATOR/
DIRECTOR:		MARIA FERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 223-7240
CITY:SOLEDADSTATE: CAZIP CODE:
93960
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/14/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Maria FernandezTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On August 14, 2025, at 9:30AM, Licensing Program Analyst (LPA) Martha Jimenez-Villanueva met with Maria Fernandez, applicant, to conduct an announced Relocation/pre-licensing inspection in response to Licensee/Applicant, Maria Fernandez request of change location. Applicant is currently licensed with a Large Family Child Care home, facility number 274450234 at 517 Indian Warrior Way, Soledad CA 93960. Applicant was present in the home alone. Per Applicant, the adults that reside in the home are herself, her husband Lucio, her son Eddie, her daughter Sarahi and her daughter/assistant Danneli. No minor children reside in the home. The home received a Fire Inspection Clearance granted on July 21, 2025 by the Cal Fire by the City of Soledad. There is pull station near the entrance door. FCCH is in a one story home with (4) bedrooms and two (2) baths.

Days and hours of operation will be Monday to Friday from 5:00AM to 6:00PM. Applicant understands, children cannot stay in the home for more than 24 continue hours. Applicant completed her Preventative Health and Safety Child Care Training including the lead poisoning training on 05/28/2025. Applicants’ pediatric CPR and First Aid certifications are current and will expire on 05/15/2027. Applicant completed Mandated Reporter training on 02/13/2024. Applicants’ immunization for measles, pertussis, Flu (opt/out) and TB test are on file. The applicant owns the home and provides the Mortgage Bill as proof of control of property. The home has current Insurance Liability with State Farms.

LPA toured indoor/outdoor areas of the home during today's inspection. There are no stairs, no wall heater inside the home. There is a glass covered fireplace in the living room, applicant stated will be removing the fireplace in the near future. The children’s area includes kitchen, living/dining room, one bedroom, one storage closet and a bathroom. The hallway doors have secured lock knobs. Off limit areas inside the home: one master bedroom with walking closet and bath, two bedrooms, laundry area and attached garage. Off limit areas outside the home: driveway, the front and the gardening area around the backyard. The backyard is fenced. Applicant understands that prior to making any change related to the on or off limits must be reported to Licensing Program.
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NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2025
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 5
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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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: FERNANDEZ, MARIA
FACILITY NUMBER: 274417512
VISIT DATE: 08/14/2025
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The home is clean, orderly, including central heat system, and fan/ventilation for safety & comfort for children in care. Applicant has a valid phone in the home. There are sufficient toys, supplies, and equipment for the day care children in the indoor and outdoor areas. LPA observed a mounted fully charged fire extinguisher (3A40BC), working combo smoke & carbon monoxide detector and no bodies of water. Applicant stated there is no weapons/ammunition, no pets and not poisons in the home.

Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children and are top kitchen cabinet, top laundry cabinet and top rack in the garage. LPA reminded applicant that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. Applicant stated that a child will be isolated in the bedroom, if necessary, due to illness or communicable disease. Applicant has a First Aid kit and a touch less thermometer in the home; Licensee stated that she does not transport any day care children. Applicant understands car seats cannot be used to sleep children in care.

Applicant understands that she must be present in the home at least 80% of the operating hours of the day care daily and ensure children are supervised at all times. Supervision of children was discussed with Applicant and she understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her current capacity options and that she cannot have more than 14 children in the home at any time and a qualified assistant must be present and ratio (age of the children) must be observed. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio must be observed as well. LPA discussed and provided applicant with the ratio and capacity chart.

Forms of discipline to be used by Applicant: talking to children and redirection. Applicant understands that children's personal rights should not be violated, including no corporal punishment. Isolation of sick children, supervision of children, capacity options for a large license, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed the applicant that fire/disaster drills must be practiced at least once every 6 months and documented. Department website www.cdss.ca.gov provided to applicant.

Applicant stated that she will not administer any medication to the children at this time. 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/.

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NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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: FERNANDEZ, MARIA
FACILITY NUMBER: 274417512
VISIT DATE: 08/14/2025
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Roster Report was reviewed on 06/19/2025 indicating that all the adults residing in the home or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 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 this regulation is violated.

LPA reviewed with applicant, the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided for the applicant.

LPA discussed the safe sleep regulations with applicant, 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. LPA also informed applicant, 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.

LPA discussed the requirements of Assembly Bill (AB) 633 with the applicant. LPA discussed "zero tolerance" related regulations with the applicant.

On this date, 06/16/2025 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: FERNANDEZ, MARIA
FACILITY NUMBER: 274417512
VISIT DATE: 08/14/2025
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Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Maria Fernandez in Spanish, and advised her that a Large Family Child Care Home license will be approved upon completion of the following:

Review and Approval from a Licensing Program Manager (LPM).

NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC809 (FAS) - (06/04)
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