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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444407398
Report Date: 12/08/2022
Date Signed: 12/14/2022 04:09:58 PM

Document Has Been Signed on 12/14/2022 04:09 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:ROMERO, MARIAFACILITY NUMBER:
444407398
ADMINISTRATOR:ROMERO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 288-0285
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
12/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Maria RomeroTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Maria Romero for an unannounced Required – 1 year annual inspection. LPA was granted access to the home by the Licensee. LPA also observed seven day care children (1 infant, 6 preschool, in the home during today's inspection and assistant, Jasmine Ramirez. Licensee is operating within the capacity and ratio requirements of her license. LPA observed the required postings, including the facility license, near the main day care area of the home. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. Maria states that herself, foster daughter (Yulissa Romero) are the only adults living in the home. Maria's daughter, Alexandria Romero resides in the home but is currently attending Fresno State University. Licensee has a 14 year old son who lives in the home.

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 10/10/2022. Licensee has current CPR and First Aid certifications, expiring on 02/11/2024. Licensee has the required vaccines (MMR, Tdap), declines the influenza vaccine. Licensee is current with her Mandated Reporter Training for Child Care Workers. LPA reviewed seven children's files and the files were complete with the required forms and immunization records. Infant in care is missing the 15 minute sleep checks. Infant has the LIC9227 on file. LPA reviewed two staff files (Licensee and Assistant, Jasmine Ramirez) and the files were complete with the required forms and immunization records.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensees has a working telephone in the home. The home is clean, orderly, (including heating/ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. LPA did not observe any wall heater units inside the home. Off limit areas in the home: garage, entire upstairs, downstairs bedroom.

LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. LPA observed barricaded stairs. There is a fire place in day care room that is barricaded. Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. LPA reminded Licensee that poisons are to be locked.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2022
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: ROMERO, MARIA
FACILITY NUMBER: 444407398
VISIT DATE: 12/08/2022
NARRATIVE
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Licensees states that they provide all the meals (snacks, lunch, and dinner) for the day care children. Licensee understand that any food brought from home shall be labeled with each child's name and properly stored. Licensee has a first aid kit in the home. Licensee understands that smoking is prohibited in the home.

Licensee states that she do not administer any medications to the day care children at this time. 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 understand that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands the capacity/ratio options and they understand that they cannot have more than 14 children present in the home without at least two qualified adults present. Licensee states that a child will be isolated in the living room area if necessary due to illness or communicable disease. Licensee states transports children to and from school. 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. Today, LPA observed an infant strapped in a car seat while being rocked.

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 discussed the safe sleep regulations with the Licensees 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 Licensees 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, Maria Romero. Deficiencies cited on 809D. Licensee was cited a type A deficiency upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.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: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 12/14/2022 04:09 PM - It Cannot Be Edited


Created By: Elizabeth Berumen On 12/08/2022 at 03:18 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: ROMERO, MARIA
FACILITY NUMBER: 444407398

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102423(a)(2)
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: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above. LPA observed an infant stapped in a car seat being rocked which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/08/2022
Plan of Correction
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Car seats are to be used for transporting child(ren) in vehicle. Licensee's assistant was asked to remove child from car seat and place the car seat in an off limits area.
Licensee to send a written plan of correction stating she understands safe sleep regulations and that she understands that a car seat is only to be used when transporting child(ren).
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mary Segura
LICENSING EVALUATOR NAME:Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2022


LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 12/14/2022 04:09 PM - It Cannot Be Edited


Created By: Elizabeth Berumen On 12/08/2022 at 03:18 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: ROMERO, MARIA
FACILITY NUMBER: 444407398

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

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 1 is an infant and is missing the 15 minute sleep checks which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/13/2022
Plan of Correction
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LPA provided Licensee with a sleep log. Licensee is to complete a sleep check log for two days and send a copy to LPA by plan of correction date of 12/13/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mary Segura
LICENSING EVALUATOR NAME:Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2022


LIC809 (FAS) - (06/04)
Page: 2 of 4