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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444407897
Report Date: 12/16/2021
Date Signed: 12/16/2021 06:11:25 PM

Document Has Been Signed on 12/16/2021 06:11 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:MELGOZA, GLORIAFACILITY NUMBER:
444407897
ADMINISTRATOR:MELGOZA, GLORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-8732
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
12/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Gloria MelgozaTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Gloria Melgoza for an unannounced Required – 1 year annual inspection. LPA was granted access to the home by the Licensee. LPA observed two day care children (1 infant, over 12 months old and 1 pre-schooler). The Licensee was operating within their capacity and ratio requirements. LPA observed the required postings, including the facility license, near the day care area. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. Licensee states that herself and her husband (Manuel Marujo) are the only adults living 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 December 6, 2021. Licensees has the required vaccinations (MMR, Tdap, & influenza) and is current with the Mandated Reporter Training for Child Care Workers (expires 01/15/2022). The Licensees CPR and First Aid are current and expires in 01/17/2022.

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. The Licensees states that she does not have any pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Licensee understands that poisons are to be locked. The Licensees states that she currently is not administering any medication to the day care children at this time. LPA observed a screened fire place and barricaded stairs. The off limit area in the home are entire upstairs (3 bedrooms and 2 bathrooms) and garage.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2021
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: MELGOZA, GLORIA
FACILITY NUMBER: 444407897
VISIT DATE: 12/16/2021
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A review of staff records on December 16, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded the Licensees of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
Supervision of children was discussed with the Licensees and they understand that they must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensees understand their capacity options and they understand that they cannot have more than 14 children in the home at any time without two fully qualified adults present. The Licensees state that she does transport day care children to and from school. The Licensees 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.

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

LPA conducted an exit interview with the Licensees and advised them that no deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021
LIC809 (FAS) - (06/04)
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