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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410473
Report Date: 11/30/2022
Date Signed: 11/30/2022 04:40:30 PM

Document Has Been Signed on 11/30/2022 04:40 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:COVARRUBIAS, NINFAFACILITY NUMBER:
434410473
ADMINISTRATOR:COVARRUBIAS, NINFAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 776-1729
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
11/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Ninfa Covarrubias and Kenya CovarrubiasTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Licensee Ninfa Covarrubias and her daughter, Kenya Covarrubias, who helps with the daycare. Present during today's inspection were six (6) children, whom two (2) were infant age.

License and notification of parent's rights were posted. There is a working phone in the home.

LPA toured the inside and outside of the home with Licensee's daughter, Kenya. The off-limit areas of the home are the garage and the entire upstairs. There are stairs in the home, which are barricaded. There are toys and equipment for children, which are age-appropriate. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 10/25/2022. Kenya stated that there are no weapons, such as firearms, stored in the home.

The backyard is used and is fenced. There was no bodies of water observed during today's inspection. LPA reminded Kenya to dump out any containers that collect water. During inspection, LPA observed that there was a rodent in the backyard. She stated that she will have her brother set a trap for any rodents. Kenya stated that they will not use backyard until rodent is caught.


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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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: COVARRUBIAS, NINFA
FACILITY NUMBER: 434410473
VISIT DATE: 11/30/2022
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LPA reviewed sleep log during today's inspection. 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.

Licensee does not provide Incidental Medical Services (IMS). 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: http://www.ada.gov/childqanda.htm

Licensee and her daughter does transport children and understands that children cannot be left alone and unattended in parked vehicles. Licensee and her daughter has a valid license.

A copy of a facility roster was obtained. Six (6) children's files were reviewed during today's inspection. The records reviewed include but not limited to immunization records and parent's rights. Kenya stated that she will have C-1 and C-2's parents re-fill out LIC 700 due to changes.


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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC809 (FAS) - (06/04)
Page: 2 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: COVARRUBIAS, NINFA
FACILITY NUMBER: 434410473
VISIT DATE: 11/30/2022
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Licensee and Kenya's files were also reviewed. The records reviewed include but not limited to Mandated Reporter training and immunization records. Licensee and Kenya completed Mandated Reporter training on 11/23/2022. Licensee and Kenya have a valid CPR/1st Aid, which expires on 03/20/2023. Licensee is missing immunization records for measles. Kenya stated that Licensee will obtain immunization record and send proof to Licensing.

The adults 18 and over living in the home are Licensee, her spouse, and three adult children. All adults have cleared fingerprints. A-1 is missing TB test and LIC 508. A-2 is missing LIC 508. Kenya stated that she will obtain LIC 508 for A-1 and A-2; along with the TB test for A-1 and send it to Licensing. 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 obtained a copy of the proof of property during today's inspection.

Licensee will submit the following:
  • Immunization Record for Measles (MMR) for Licensee
  • TB test and LIC 508 for A-1
  • LIC 508 for A-2


As a result of this inspection, no deficiencies were issued. Exit interview was conducted and report was reviewed with Licensee's daughter, Kenya Covarrubias. 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: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC809 (FAS) - (06/04)
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