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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406261
Report Date: 07/14/2022
Date Signed: 07/15/2022 08:37:04 AM

Document Has Been Signed on 07/15/2022 08:37 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:MORALES, LOURDESFACILITY NUMBER:
444406261
ADMINISTRATOR:MORALES, LOURDESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-1870
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
07/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lourdes MoralesTIME COMPLETED:
12:45 PM
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Licensing Program Analysts (LPAs) Elizabeth Berumen and Araceli Almaraz for an unannounced Required – 1 year annual inspection. LPA was granted access to the home by Licensee's assistant, Maria De Jesus Rios. LPAs also observed nine day care children (1 infant & 1 preschool and 6 school age) in the home during today's inspection. Licensee was operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. Licensee states that herself, her husband (Salvador Garcia) and daughter (Adriana Garcia) are the adults living in the home.
Licensee has a working telephone (land line) and provided LPA with her cell number today (831) 539-6105.
LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on 07/11/2022. Licensee states that she has liability insurance through DCI Insurance and LPA observed a valid policy verifying coverage during today's inspection. Licensee has current CPR and First Aid certifications, expiring 06/04/2023. Licensee has the required vaccines (MMR, Tdap). Licensee had flu shot on 02/24/2022. Licensee is current with her Mandated Reporter Training for Child Care Workers (expiration: 12/18/2022)

LPA reviewed nine children's files and the files were complete with the required forms. LPA reviewed two staff files (Licensee and Assistant) and the file was complete with the required forms.
LPAs toured the indoor and outdoor areas of the home during today's inspection. The home is clean, orderly, (including heating/fans/ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. There are no stairs in the home. LPA observed a barricaded fire place, barricaded wall heater and barricaded water heater. Off limit areas inside the home: two bedrooms, detached garage, studio (where daughter, Adriana lives) and two storage sheds in the backyard. Licensee has two pet dogs; both are current with shots.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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: MORALES, LOURDES
FACILITY NUMBER: 444406261
VISIT DATE: 07/14/2022
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LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. Licensee states there are no weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Licensee keeps medication in her off limits bedroom. Licensee states that she currently is not does not administer any medications to the day care children.

Licensee states that she provides breakfast, snacks, and lunch to the day care children. Licensee states that she understands that any food brought from home needs to be labeled with each child's name and properly stored. Licensee states that nobody smokes and she understands that smoking is prohibited in the home.

Incidental Medical Services (IMS) policy was discussed. 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 (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

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity/ratio options and she understands that she cannot have more than 14 children present in the home with at least one qualified adult present. Licensee states that a child will be isolated in the living room area if necessary due to illness or communicable disease. Licensee states that she does transport day care children. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

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

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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: MORALES, LOURDES
FACILITY NUMBER: 444406261
VISIT DATE: 07/14/2022
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LPA discussed the safe sleep regulations with the 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 the 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.

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 the Licensee, Lourdes Morales. No deficiencies issued during today's inspection.

NOTICE OF SITE VISIT ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

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

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
LIC809 (FAS) - (06/04)
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