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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444409058
Report Date: 11/29/2022
Date Signed: 11/29/2022 12:16:53 PM

Document Has Been Signed on 11/29/2022 12:16 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:HERRERA, FLORENCIAFACILITY NUMBER:
444409058
ADMINISTRATOR:FLORENCIA HERRERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 740-2288
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 3DATE:
11/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Florencia HerreraTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Licensee, Florencia Herrera, for an unannounced Required- 1 Year Inspection. LPA was granted access to the home by the Licensee and toured both indoors and outdoors during the inspection. Upon arrival, there were 3 preschool-age children, the Licensee and Assistant (Rita) present, which is compliant with the home license capacity and ratio requirements. Additionally present in the home during today's inspection was the Licensee's father-in-law and adult son (Mark). LPA observed all required postings near the entrance to the home and the hours of operation are Monday – Friday, 6:30AM-6:00PM.

Licensee states that adults, over the age of 18, residing in the home are: herself, her spouse (Marcos), her sons (Mark & Isaac), and her father-in-law (Manuel). All adults residing in the home have Criminal Background Check Clearance and signed Criminal Record Statements (LIC508). LPA advised that all adults living in the home should also have negative tuberculosis (TB) test.

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 reviewed facility roster (LIC9040) and fire/disaster drill log during todays inspection. The last fire/disaster drill was conducted in 5/2021 and LPA advised that drills should be conducted every six months. LPA observed a fully charged 3A40BC fire extinguisher (last serviced: 1/2020), functioning smoke detector and carbon monoxide detector. LPA advised that fire extinguishers are serviced annually. The Licensee states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. The Licensee states that there are no weapons or firearms in the home.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: HERRERA, FLORENCIA
FACILITY NUMBER: 444409058
VISIT DATE: 11/29/2022
NARRATIVE
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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 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

Indoor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Off-limits areas inside the home include: living room, three (3) bedrooms, and one (1) restroom. There are no open-faced heaters in the home. The Licensee has an active waiver for a wood burning stove and LPA observed it was cool to the touch and now located in an off-limits area of the home. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. Drinking water is readily available for children via water dispensers and disposable cups. The bathroom in the home is clean, sanitary, and operable. The Licensee has a working telephone in the facility. Stairs are barricaded appropriately to keep day care children safe. During today's inspection, LPA observed children watching a movie and eating breakfast.

The outside area of the home was inspected and observed to be fenced in. Off-limit areas outside of home include: everything outside of fenced area for children. LPA observed sufficient play-equipment and supplies for the children that are in good condition and age-appropriate. Outside play area is equipped with play structure, swings, and a trampoline for children. LPA advised placing climbing structure on turf or other soft surface for children to play on safely as it was observed to be on top of dirt during todays inspection. No outdoor bodies of water were observed.

LPA discussed the safe sleep regulations with 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.

1 child’s file was reviewed during todays inspection and all required documents were present. The Licensee states that additional children in care are her god children who live across the street and LPA advised that any children who are drop-in should still maintain proper documentation.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
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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: HERRERA, FLORENCIA
FACILITY NUMBER: 444409058
VISIT DATE: 11/29/2022
NARRATIVE
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The Licensee, Assistant, and Home Resident files were reviewed and most required documents were present. LPA advised the Licensee on documents that need updating, such as CPR/First-Aid, Mandated Reporter training, and proof of immunization (tDap, MMR, flu) /tuberculosis test.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The Licensee states that she will transport day care children on an as needed basis for school-age children in care. LPA observed that the Honda Pilot for transportation has current vehicle registration and the Licensee has current CA drivers license that expires 2/18/2023. The LPA reminded Licensee that children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Exit interview conducted and report was reviewed with the Licensee, Florencia Herrera.

As a result of todays inspection, deficiencies were cited, see 809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
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Document Has Been Signed on 11/29/2022 12:16 PM - It Cannot Be Edited


Created By: Cortney Nelson On 11/29/2022 at 11:20 AM
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: HERRERA, FLORENCIA
FACILITY NUMBER: 444409058

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(b)
Operation of A Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to children in care. During today's inspection, LPA observed garbage bag in the kitchen, locks need replacing on drawers/cabinets in kitchen, and walk way to restroom needs to be cleaned.
POC Due Date: 12/09/2022
Plan of Correction
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The Licensee will replace broken locks in the kitchen or relocate sharp/dangerous items higher, maintain trash in a trash bin (not open garbage bag in kitchen), and reorganize walk way to bathroom for children to do so safely by 12/9/2022. Pictures of repairs will be submitted to the Department.
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above as cleaning compounds were observed under the sink used for children, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/02/2022
Plan of Correction
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The Licensee will relocate items that were under the sink and LPA advised a lock for under if the items will be returned to the same area. Pictures of relocated cleaning compounds to be submitted by 12/2/2022. LPA advised Licensee take time to relocate any cleaning compounds that may be accessible in the kitchen or bathroom.
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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022


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Document Has Been Signed on 11/29/2022 12:16 PM - It Cannot Be Edited


Created By: Cortney Nelson On 11/29/2022 at 11:20 AM
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: HERRERA, FLORENCIA
FACILITY NUMBER: 444409058

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as the last fire drill conducted was 5/2021, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/09/2022
Plan of Correction
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The Licensee will conduct fire/emergency drill with the children and submit proof of completion by 12/9/2022 to the Department.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above for herself, her assistant, and her adult son, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/16/2022
Plan of Correction
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The Licensee will complete Mandated Reporter training for herself, her Assistant (Rita), and her son (Mark) for Child Care Providers (AB1207) by 12/16/2022 and submit proof of completion to the Department. (www.mandatedreporterca.com) LPA advised training should be renewed every 2 years.
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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022


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Document Has Been Signed on 11/29/2022 12:16 PM - It Cannot Be Edited


Created By: Cortney Nelson On 11/29/2022 at 11:20 AM
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: HERRERA, FLORENCIA
FACILITY NUMBER: 444409058

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above for herself and her assistant, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/09/2022
Plan of Correction
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The Licensee will submit proof of completion or registration for pediatric First-Aid/CPR for herself and her assistant by 12/9/2022. LPA advised that at least one person with valid certification must be present with the children at all times.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, record review, and interview, the licensee did not comply with the section cited above for her adult son who helps with the children, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/09/2022
Plan of Correction
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The Licensee will submit proof of immunization (tDap, MMR, flu- or written declination) by 12/9/2022 for her adult son who helps watch the children.
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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 11/29/2022 12:16 PM - It Cannot Be Edited


Created By: Cortney Nelson On 11/29/2022 at 11:20 AM
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: HERRERA, FLORENCIA
FACILITY NUMBER: 444409058

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for 2 out of 3 children present today, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/09/2022
Plan of Correction
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The Licensee will obtain required documentation for her two (2) god children in care today and submit to the Department by 12/9/2022. LPA advised that even drop-in children should have the required documentation.
Type B
Section Cited
CCR
102369(b)(9)
102369 Application for Initial License (b) The Applicant shall provide all of the following information at the time of submission of the application: (9) Evidence of current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for her adult sons who live in the home and Assistant present today, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/16/2022
Plan of Correction
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3
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The Licensee will submit proof of negative tuberculosis (TB) test for her adults sons and Assistant (Rita) to the Department by 12/16/2022.
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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022


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