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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406129
Report Date: 04/07/2023
Date Signed: 04/11/2023 06:56:19 AM

Document Has Been Signed on 04/11/2023 06:56 AM - 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:RENTERIA, CRISTINAFACILITY NUMBER:
444406129
ADMINISTRATOR:RENTERIA, CRISTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 728-9502
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
04/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Cristina RenteriaTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen conducted an unannounced Required- 1 Year inspection. LPA met with Licensee, Cristina Renteria and explained the reason for the inspection. Upon arrival, Licensee, her husband, and five day care children, and Licensee's 9 year old grandson. One of the children present is an infant. Licensee states there are five adults living in the home, Licensee, (her father, Felipe Sanchez-Mancilla- husband, Genaro Renteria, Daughter- Elizabeth Renteria and son-in-law, Juan Ramirez Meza). All adults living in the home have criminal record clearances. 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.
All required posted materials were posted by the entrance. The day-care is open Monday thru Friday from 6:00 AM to 6:00 PM. There are no active waivers or exceptions for this facility.
LPA toured the indoor and outdoor areas of the home. The off limit areas in the home are entire upstairs (2 bedrooms, 1 bathroom) 3 downstairs bedrooms and garage. Off limit areas outside the home: left side yard and storage shed. No bodies of water were observed.
LPA observed a fully charged 2A10BC fire extinguisher. The smoke & carbon monoxide detectors were tested and proved to be functioning. LPA observed that stairs are barricaded by a partial door.
Licensee states that there are no weapons or firearms in the home. LPA observed a current children's roster and copy was obtained during the inspection. Fire/disaster drill was conducted on 03/15/23.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2023
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: RENTERIA, CRISTINA
FACILITY NUMBER: 444406129
VISIT DATE: 04/07/2023
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LPA observed that the home is clean and orderly. Cleaning products, sharp objects, and other items that are dangerous to children were stored inaccessible. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. The children's bathroom is clean, sanitary, and operable. The home has a working telephone which is (831)728-9502, cell (831)706-6751. Licensee's email address is cristina5492@yahoo.com.
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), Affidavit Regarding Liability Insurance (LIC 282), Immunization Records, Notification of Additional Children in Care (LIC 9150), and Acknowledgement of Receipt of Licensing Report (LIC 9224).

LPA reviewed a helper's file (Genaro Renteria) for the following records: Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), Employee Rights (LIC 9052), required immunizations, TB test, and Mandated Reporter Training. Licensee's Mandated Reporter Training expires on May 12, 2024. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years. Licensee has current Pediatric CPR/First Aid certification with an expiration date of June 9, 2024.

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
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023
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: RENTERIA, CRISTINA
FACILITY NUMBER: 444406129
VISIT DATE: 04/07/2023
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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, Cristina Renteria.

As a result of today's inspection, deficiencies cited on the following 809D page:

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: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/11/2023 06:56 AM - It Cannot Be Edited


Created By: Elizabeth Berumen On 04/07/2023 at 01:21 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: RENTERIA, CRISTINA
FACILITY NUMBER: 444406129

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as child 3 is missing 15 minute sleep check log which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/12/2023
Plan of Correction
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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 Child 3 is missing the Individual Infant Sleeping Plan (LIC9227) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/12/2023
Plan of Correction
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Licensee, Cristina Renteria agrees to submit a copy of the LIC9227 to LPA Berumen by Plan of correction date of April 12, 2023. Cristina is to file the original in 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: 04/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2023


LIC809 (FAS) - (06/04)
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