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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416000
Report Date: 06/16/2022
Date Signed: 06/21/2022 04:36:49 PM

Document Has Been Signed on 06/21/2022 04:36 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:CALDERON, KARINAFACILITY NUMBER:
444416000
ADMINISTRATOR:KARINA CALDERONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 288-0261
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Karina CalderonTIME COMPLETED:
03:15 PM
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Licensing Program Analysts (LPA) Elizabeth Berumen met with Licensee, Karina Calderon for an unannounced Required – 1 year annual inspection. LPA was granted access to the home by the Licensee. LPA observed 10 day-care children (one infant, nine preschoolers) and Licensee's assistant (Elvia Abrego) in the home during today's inspection. Licensee was operating within her capacity and ratio requirements. LPA observed the facility license, near the front entrance to the day care area, emergency disaster plan, parents rights, and the earthquake preparedness checklist posted. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. Licensee states there are ten adults living in the home. The home is divided into two living quarters. Licensee lives in the primary residence along with Elvia Abrego, Yarely Contreras, Israel Contreras, Dulce Calderon, Gabriel Calderon, and Ramiro Namboescutia. One minor child, 8 year old (Elvia's daughter).
Three adults reside in the back portion of the home; Marisol Calderon, Florinda Calderon and Fernando Calderon; with there two minor children ages 8 and 5.

LPA toured the indoor and outdoor areas of the home during today's inspection. Off Limit areas inside the home are three bedrooms, 3 hall closets, kitchen and back portion of the home (attached separate living quarter). Licensee has a working telephone in the home. The home is clean, orderly, (including heating/air conditioning/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 observed two barricaded wall heaters in the home. Backyard is fenced. Licensee uses left portion of the backyard; other portion is off limits and has a barricade to prevent children to access off limit backyard area. There were no bodies of water observed.

LPA observed a fully charged 3A40BC fire extinguisher. LPA observed smoke and carbon monoxide detectors. Licensee states that she does not have any weapons in the home.
LPA reviewed a current Child Care Facility Roster. LPA reviewed fire/disaster drill log; The last drill was completed on June 7, 2022. Licensee states that she does have liability insurance for the day care through ACORD Insurance and LPA observed a valid policy verifying coverage. Licensee has current CPR and First Aid certifications; expiring 02/16/2023. Licensee has the required vaccines (MMR, Tdap) and is current with her Mandated Reporter Training for Child Care Workers (exp: 03/15/23). Licensee states she had her flu shot in February; LPA asked her to place immunization record in her file to show proof of influenza (flu) vaccine. LPA reviewed six children's files and the files were complete with the required forms, including the Individual Infant Sleeping Plan (LIC 9227) for infant and infant sleeping log. LPA reviewed Licensee and assistants (Elvia Abrego) file.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2022
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: CALDERON, KARINA
FACILITY NUMBER: 444416000
VISIT DATE: 06/16/2022
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 Licensee has a pet dog that is kept in off limit dog run. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Licensee states that she does not administer any medications to the day care children. Licensee states that nobody smokes and she understands that smoking is prohibited in the home.

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 understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity/ratio options and she understands that she cannot have more than 14 children present in the home with qualified assistant. Licensee states that a child will be isolated if necessary due to illness or communicable disease. Licensee states that does not transport any day care children. 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.

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 Licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Licensee 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, Karina Calderon. No deficiencies issued during today's inspection.

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: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
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