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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406138
Report Date: 10/17/2024
Date Signed: 10/17/2024 12:02:26 PM

Document Has Been Signed on 10/17/2024 12:02 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:SANCHEZ, LOURDESFACILITY NUMBER:
444406138
ADMINISTRATOR/
DIRECTOR:		SANCHEZ, LOURDESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 728-3806
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
10/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Lourdes SanchezTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On 10/17/24 at 10:00 AM., LPA Trujillo met with licensee Lourdes Sanchez for a case management Plan of Correction (POC) visit and to amend a deficiency cited on a visit on 10/03/24. Present with licensee were licensee spouse with 10 children: three (3) infants, seven (7) preschool age.

LPA observed play pen with mattress and fitted sheet, LPA observe LIC 9224 Acknowledgement of Receipt of Licensing Reports with children files.

Deficiency cited in error for CCR 102425(e)Infant Sleep was amended for the visit on 10/03/24, no deficiency cited.

As a result of the site visit on 10/03/24 a type B deficiency has been cited, LPA observed licensee remove napping Infant Child 2 from a bassinet.

Type B Deficiencies were cited today. Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made

Exit interview conducted and report was reviewed with the licensee Lourdes Sanchez.

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: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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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Document Has Been Signed on 10/17/2024 12:02 PM - It Cannot Be Edited


Created By: Teodoro Trujillo On 10/17/2024 at 11:37 AM
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: SANCHEZ, LOURDES
FACILITY NUMBER: 444406138

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2024
Section Cited
CCR
102423(a)(4)

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Personal Rights (a)Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

This requirement is not met as evidenced by:
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Licensee will submit a written statement of her understanding of CCR 102423(a)(4) to the San Jose Regional Office by close of business 10/31/24.
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Based on observation, interview and record review, the licensee did not comply with the section cited above inC2 was removed from bassinett during site visit, which poses/posed a potential health, safety or personal rights risk to persons in care.
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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:Susy Cervantes
LICENSING EVALUATOR NAME:Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2024


LIC809 (FAS) - (06/04)
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