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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274401369
Report Date: 09/20/2024
Date Signed: 09/20/2024 02:42:32 PM

Document Has Been Signed on 09/20/2024 02:42 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:VARELA, MARIAFACILITY NUMBER:
274401369
ADMINISTRATOR/
DIRECTOR:		VARELA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 424-3975
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 7DATE:
09/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:28 PM
MET WITH:Maria VarelaTIME VISIT/
INSPECTION COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual required inspection to the home today. LPA met with Maria Varela, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM. The adults that reside in the home are the Licensee, her spouse Jose, and her daughter and helper Viviana. LPA observed that Licensee's helper Viviana was present and helping the Licensee during today's inspection. There were seven children present during today's inspection. Licensee's certifications for CPR and First Aid card is current and will expire on 1/20/26 for both licensee and her helper Viviana.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a picture of the Child Care Facility Roster during today's inspection. LPA reviewed five children's files and observed that parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification and emergency information forms are in each file. LPA observed the last fire drill was documented on 5/15/24.

The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas in the home are: 3 bedrooms, and 1 bathroom and the garage. LPA observed there are not stairs in the home and a barricaded fireplace in the living room. The off limits area outside the home is the right side yard, and a locked shed in the back yard. LPA observed the home has a back yard and it is fenced. Licensee uses the back yard as playground whenever the weather allows it. There is a 2A10BC fire extinguisher in the home, working smoke and Carbon Monoxide detectors and no bodies of water. The Licensee states that she does not have any weapons in the home. LPA reminded licensee that all the detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.

Licensee has in file proof of immunization for influenza, pertussis and measles for herself, and her helpers according with the SB792.

Report dated 9/20/24 continues in page 2.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 09/20/2024 02:42 PM - It Cannot Be Edited


Created By: Fermin Campos-Jaramillo On 09/20/2024 at 01:44 PM
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: VARELA, MARIA
FACILITY NUMBER: 274401369

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above, Licensee and her helper stated they do not infants do not sleep while they are in care. Thee licensee does not have any detailed log of the infants sleep patterns which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/04/2024
Plan of Correction
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Licensee shall start documenting the infants sleep from now and until the infants reach the age of two years old. Licensee will submit to Licensing Department no later than October 4, 2024 proof of documenting (Log provided) for the three infants in care (ch 1, 4, and 5) for the period September 20 to October 3, 2024.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above, No form Lic9227 in file for one infant (ch #5) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/04/2024
Plan of Correction
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Licensee will submit no later than Octover 4, 2024 a copy of the complete form Lic9227 for infant (ch #5)
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:Susy Cervantes
LICENSING EVALUATOR NAME:Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2024


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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: VARELA, MARIA
FACILITY NUMBER: 274401369
VISIT DATE: 09/20/2024
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Report dated 9/20/24 continues from page 1.

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. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time, a helper must be present, and ratio (age of the children) shall be observed. Licensee understands that in absence of a helper her license capacity is reduced to only 8 children and ratio shall be observed as well. The Licensee states that her daughter and helper Viviana transports children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.
Department website: www.ccld.ca.gov provided to Licensee.

LPA observed that the Licensee and her helper Viviana have renewed the "mandated reporter" training on 11/10/22 and 1/17/24 respectively. Licensee understands the training shall be renewed every two years for all the adults in contact with children. LPA referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training.

A review of staff records on 9/18/24 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

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 Child Care 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 discussed the safe sleep regulations with 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.

***********************Report dated 9/20/24 continues on page 3.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
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: VARELA, MARIA
FACILITY NUMBER: 274401369
VISIT DATE: 09/20/2024
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******************Report dated 9/20/24 continues from page 2.
LPA also informed 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.

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)/ (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

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

During the exit interview, the LICENSEE Maria Varela confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee Maria Varela in Spanish.

Two type B deficiencies were cited today.

Failure to comply with the Plan Of Corrections (POC) by the due date on LIC809D shall result in an immediate civil penalty of $100 per day per each deficiency.

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

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
LIC809 (FAS) - (06/04)
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