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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444408356
Report Date: 02/13/2025
Date Signed: 02/13/2025 11:23:24 AM

Document Has Been Signed on 02/13/2025 11:23 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PEREZ, SANDRAFACILITY NUMBER:
444408356
ADMINISTRATOR/
DIRECTOR:		PEREZ, SANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-5808
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 3DATE:
02/13/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Sandra PerezTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On February 13, 2025, Licensing Program Analyst (LPA) Darnella Barnes and Licensing Program Manager (LPM) Belinda Devall conducted an unannounced 3 year required inspection at the residence of Sandra Perez licensee. The purpose of the inspection was explained, and Licensee granted access. Licensee received the Entrance Checklist (LIC 126). The home was toured to conduct a Health and Safety Inspection.

The facility operates Monday through Friday, 6:00 a.m. to 6:00 p.m. Required postings, including the Facility License, Notification of Parent's Rights (PUB 393), Emergency Disaster Plan (LIC610A), and Earthquake Preparedness Checklist (LIC 9148), were observed near the front entrance. The last fire/disaster drill date was 1/18/2025; Licensee was reminded of the six-month drill and documentation requirement.

Three preschool children and Spouse Enrique Ornelas were present, which is compliant with the home license capacity and ratio requirements. Staff-to-child ratio and supervision, including the licensee's required presence during daycare hours, were reviewed. Licensee was reminded that children must never be left in cars and car seats are only for travel. It was also reviewed that all suspected child abuse and other reportable incidents must be documented and reported. Children’s rights cannot be waived, even with parental consent. Licensee confirmed that adults 18 years and over residing in the home are fingerprint cleared were obtained and verified by LPA.

LPA and LPM toured the home's indoor and outdoor areas. Off-limit indoor areas include living room, kitchen, dining room, 3 bedrooms, 2 bathrooms, and attached garage. Off-limit outdoor areas include left side yard and area outside of gated play area. There is a rental unit in the backyard that is additionally off-limits.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: PEREZ, SANDRA
FACILITY NUMBER: 444408356
VISIT DATE: 02/13/2025
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 These areas are secured by doors and barriers. Licensee was advised that Licensing must be notified, and an inspection arranged before using off-limit areas for daycare. Observations included a fully charged 3A-40B-C fire extinguisher last serviced 4/2024, working smoke and carbon monoxide detectors, and a functioning telephone. The home was clean, well ventilated, and stocked with safe, age-appropriate toys. All poisons were locked, and hazardous items were secured out of children's reach. No bodies of water were observed.

Licensee was reminded that no one is allowed to smoke at the daycare. Baby walkers, bouncers, jumpers, and similar items are not allowed and must be kept away from the children. Licensee confirmed there are no guns or ammunition at the house. Licensee was also reminded to notify licensing before making any changes to the house or yard.

Licensee's CPR/First Aid certification expires on 3/14/2025. The Preventive Health certification expires on 03/14/2025 and Safety and Mandated Reporter training certificates expires 9//27/2026. LPA and LPM reminded Licensee of the two-year renewal requirement for both Mandated Reporter training and CPR/First Aid certification.

Licensee has required vaccinations MMR, Pertussis, and flu. LPA and LPM reviewed the facility roster (LIC 9040) and five children's files, confirming all required forms were complete,Licensee has insurance for the daycare..

LPA and LPM reminded Licensee that an individual infant sleeping plan (LIC 9227) is required for each infant up to 12 months old, and nap check documentation is required until age two. In addition, all cribs must have firm mattresses and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

Licensee stated that any child displaying illness or communicable disease symptoms will be isolated in the the play area away from other children in the daycare until parent/guardian arrival.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC809 (FAS) - (06/04)
Page: 7 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: PEREZ, SANDRA
FACILITY NUMBER: 444408356
VISIT DATE: 02/13/2025
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Childcare Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA and LPM discussed safe sleep regulations with Licensee and referenced the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-sources/safe-sleep as an additional resource. LPA and LPM also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website 1 at https://www.cpsc.gov/ and recommended registering all infant devices with the CPSC for recall notifications

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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)/ (8004314-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/


Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Licensee was reminded Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, inspection the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care- licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PEREZ, SANDRA
FACILITY NUMBER: 444408356
VISIT DATE: 02/13/2025
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please inspection the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During the exit interview, the Licensee confirmed no Registered Sex Offenders reside at the facility. The LPA completed the RSO profile in FAS on December 9. 2024. A search of the California Attorney General-Megan’s Law website found no registered sex offenders at the facility address.


During today’s inspection, no deficiencies were found.

Appeals right provided.

A notice of site inspection was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Sandra Perez

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC809 (FAS) - (06/04)
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