444415939-9-27-2023-07-CC-DVIA-CW3Q4T-20230927115051

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444415939
Report Date: 09/27/2023
Date Signed: 09/27/2023 11:50:55 AM

Document Has Been Signed on 09/27/2023 11:50 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:	VASQUEZ, LORENA		FACILITY NUMBER:	444415939
ADMINISTRATOR:	LORENA VASQUEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 247-8372
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 2	DATE:	09/27/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Lorena Vasquez		TIME COMPLETED:	12:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Lorena Vasquez for a Case Management visit to amend report dated 09/12/2023. LPA explained the nature of the visit. Present were licensee, licensee's boyfriend Martin Mendoza Banuelos and two day care infants. Infants were asleep in two separate cribs with a blanket and stuffed animal. This is a repeat violation from report dated 09/12/2023. A $250 civil penalty is being assessed.

LPA amended report dated 09/12/2023 to read 102425(b)(3) instead of 102416.5(b)(3). LPA observed child 3 an 4 are missing LIC9224 for report dated 09/12/2023. LPA obtained photos of GoKids sign in sheets for records.

The following type A deficiency was cited on the attached page (809-D). Licensee was informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

LPA Deanna Villagrana informed licensee Lorena Vasquez that this report dated 09/27/2023 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deanna Villagrana informed the licensee Lorena Vasquez to provide a copy of this licensing report dated 09/27/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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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Document Has Been Signed on 09/27/2023 11:50 AM - It Cannot Be Edited

Created By: Deanna Villagrana On 09/27/2023 at 11:13 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: VASQUEZ, LORENA	FACILITY NUMBER: 444415939
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/27/2023 Section Cited CCR 102425(b)	1 2 3 4 5 6 7	Cribs or play yards shall be free from all loose articles and objects. This requirement was not met as evidenced by LPA observed two infants were asleep in two separate cribs with a blanket and stuffed animal.	1 2 3 4 5 6 7	Licensee removed items during visit while stating infants cannot sleep without blankets. LPA reminded Licensee of regulation and informed her it was a repeat violation and a $250 civil penalty was being assessed.
	8 9 10 11 12 13 14	This poses an immediate risk to the Health, Safety or Personal Rights to children in care.	8 9 10 11 12 13 14
Type A 09/28/2023 Section Cited HSC1596.8595(c)(1)	1 2 3 4 5 6 7	A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b	1 2 3 4 5 6 7	Licensee will submit LIC9224 for child 3 and 4 for report dated 09/12/2023 to CCLD by POC date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by LPA observed child 3 an 4 are missing LIC9224 for report dated 09/12/2023. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.	8 9 10 11 12 13 14

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:

Deanna Villagrana

LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

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