444406164-6-23-2021-07-CC-EBEN-C4A8XH-20210623225419

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444406164
Report Date: 06/23/2021
Date Signed: 06/23/2021 10:54:37 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/23/2021 10:54 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:	FERNANDEZ, MARIA		FACILITY NUMBER:	444406164
ADMINISTRATOR:	FERNANDEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 228-1573
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 7	DATE:	06/23/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Maria Fernandez		TIME COMPLETED:	03:45 PM

NARRATIVE

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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Maria Fernandez. LPA explained to Maria Fernandez the reason for today's inspection. Present during the inspection were 7 day care children; 1 infant, 6 preschoolers and Assistant, Patricia Solorzano.
The purpose of today’s visit is to ensure the home is in compliance with Title 22 California Code of Regulations. Hours of Operation are from Monday - Friday, 6:00 am - 6:00pm. Maria Fernandez states that there are three adults living in the home; herself, her husband, and her son, Christian Fernandez.

LPA inspected the day care area, living room, bathroom and kitchen area. Off limit areas inside the home are three bedrooms, 1 bathroom that is located in the hallway. The attached garage is also off limits. Off limits out side of the home are both side yards and storage shed. The backyard is fenced. Licensee removed the jacuzzi from the backyard. No bodies of water in the home. The Licensee states that there are no weapons in the home and no pets. The fireplace in the living room is barricaded. All detergents, cleaning compounds, medications, and other similar items are stored and inaccessible to the children. LPA reviewed and obtained a copy of facility roster. LPA reviewed a fire disaster drill; last practiced drill was May 26, 2021. LPA reviewed 7 children's files. Files contain the Family Child Care Home Addendum to Notification of parent's rights- regarding removal/exclusion (LIC995b) for her son, Alejandro Fernandez. Files also contain the LIC 700.

The home is clean, orderly and safe for the children. LPA observed sufficient materials, toys, and play equipment for the day-care children. Smoke detector and carbon monoxide detector were tested and proved to be functioning. The home has 3A40BC fire extinguisher.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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: FERNANDEZ, MARIA	FACILITY NUMBER: 444406164
	VISIT DATE: 06/23/2021

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Licensee has current CPR and First Aid certifications with an expiration date of 03/05/2023. Licensee, Maria Fernandez completed the mandated reporter, AB1207 Licensee understands the course it to be renewed every two years. Assistant, Patricia Solorzano Munoz completed the Mandated Reporter Training on 03/24/21. Assistant has immunization against pertussis and measles. TB test in file. Assistant's CPR & First Aid is current and expires on 03/05/23. LIC508, LIC9052, Acknowledgement to report child abuse is also on file.

LPA discussed Lead Safety Information (AB 2370). Chapter 676, statues of 2018, requires all child care providers, upon enrolling or re-enrolling any child, to provide the parent or guardian with written information.

Safe sleep update: LPA discussed the new “Safe Sleep” regulations with the Licensee including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensee. LPA reminded the Licensee that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.
LPA discussed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, etc.
LPA reminded Maria Fernandez that there is a balance of $70.00 (late fee) for annual fee.

Exit Interview was conducted. A copy of this report was provided to the Licensee at the conclusion of the inspection.
NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

No deficiency cited.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

LIC809 (FAS) - (06/04)

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