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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274402462
Report Date: 08/11/2021
Date Signed: 08/11/2021 02:27:35 PM

Document Has Been Signed on 08/11/2021 02:27 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:FONSECA, IRMAFACILITY NUMBER:
274402462
ADMINISTRATOR:FONSECA, IRMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 320-7556
CITY:SALINASSTATE: CAZIP CODE:
93907
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
08/11/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Irma FonsecaTIME COMPLETED:
02:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual random inspection to the home today. LPA met with Irma Fonseca, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 7:30 AM to 5:30 PM. The adults that reside in the home are the Licensee, her son Jose Luis, her daughter Veronica, and her spouse Jose Luis. There was one child present in care during today's inspection. Licensee stated is her grandchild. Licensee's certification for CPR and First Aid Card is not currenta and has expired on 7/31/2020.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the children's roster today. LPA reviewed 4 children files and they are complete. Licensee has performed a fire drill during the last six months. Last fire drill was documented on 7/13/2021

The Licensee has a working telephone in the home (landline). LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: 3 bedrooms, and one bathroom. Off limits areas outside: Licensee stated she is not currently using the back yard for childcare. The home has a back yard and it is fenced. LPA observed the home has a blocked fireplace. LPA observed a wall heater in the home, Licensee stated the wall heater has been disconnected since before she received her license.
LPA observed a fully charged 2A10BC fire extinguisher and at least one working smoke detector. LPA observed the home has a working carbon monoxide detector. LPA observed there are not stairs in the home. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.

LPA discussed Incidental Medical Services with licensee. According with the SB792, Licensee has in file proof of immunization for measles, pertussis and influenza.

Report dated 8/11/21 continues on page 2.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2021
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: FONSECA, IRMA
FACILITY NUMBER: 274402462
VISIT DATE: 08/11/2021
NARRATIVE
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Report dated 8/11/21 continues from page 1.

A review of staff records on 8/11/2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
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 and a helper must be present. Licensee understands in absence of a helper the capacity of her license is reduced in capacity and ratio to a small Family Child Care Home license (maximum 8) and ratio, must be observed. The Licensee states that she transports children via vehicle and that she understands that children cannot be left in parked vehicles unattended at any time. Licensee uses redirection and communication with children as a form of discipline.
Department website: www.ccld.ca.gov provided to Licensee.
LPA discussed the requirements of AB 633 whenever a Type A deficiency is cited. LPA also discussed "zero tolerance" related regulations with the Licensee.
Licensee stated has completed the mandated reporter training but was unable to present the certificate of completion. Licensee was advised that the training is to be renewed every two years. LPA referred the Licensee to the Department website: www.mandatedreporterca.com for additional information on the online training.
LPA advised licensee of the new regulations on Safe sleep for infant children. and provided licensee with form LIC9227. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.
LPA provided licensee with the Lead Poisoning Facts sheet.
Two type B deficiencies were cited during today's inspection. Appeal rights was printed and given to Licensee. Exit interview was conducted with licensee.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
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Document Has Been Signed on 08/11/2021 02:27 PM - It Cannot Be Edited


Created By: Fermin Campos-Jaramillo On 08/11/2021 at 02:05 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: FONSECA, IRMA
FACILITY NUMBER: 274402462

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2021
Section Cited
CCR
102416(c)

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(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.
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Licensee shall renew her pediatric CPR first aid card and will submit a copy to Licensing Department by August 25, 2021.
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This requirement was not met as evidenced by: Licensee's CPR first aid card has expired on 7/31/2020 and this poses a potential risk to the children in care.
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Type B
09/25/2021
Section Cited
HSC1596.8662(b)(1)

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child 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
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Licensee Irma Fonseca shall renew/obtain her Mandated reporter training and will submit a copy of the certificate of completion to licensing Department not later than September 25, 2021.
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every two years following the date on which he or she completed the initial mandated reporter training.
This requirement was not met as evidenced by: Licensee was unable to present a copy of her mandated reporter training. This poses a potential risk to the children in care.
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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:Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2021


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