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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274404704
Report Date: 09/01/2021
Date Signed: 09/01/2021 11:46:44 AM

Document Has Been Signed on 09/01/2021 11:46 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:NAVARRO, MARIAFACILITY NUMBER:
274404704
ADMINISTRATOR:NAVARRO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 633-8953
CITY:CASTROVILLESTATE: CAZIP CODE:
95012
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
09/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Maria NavarroTIME COMPLETED:
12:00 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 Navarro, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Saturday from 6:00 AM to 6:00 PM. Present was licensee's daughter and helper Liset. The adults that reside in the home are the Licensee, her spouse Jesus, and her adult sons Alejandro and Anthony. LPA observed there were 10 preschool children in care today. Licensee's daughter and helper Liset was helping with the children in care. Licensee's and Licensee's helper certification for CPR and First Aid Card are current and will expire on 10/03/21 and 9/07/22 respectively. Licensee is in compliance in ratio and capacity today.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the children's roster today and it is current. Licensee has documented a fire drill on 8/23/21. 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.
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, the laundry room, and one bathroom. Off limits areas outside: A storage shed at the right side of the back yard and birds cage on left side of back yard. The home has a small back yard and it is fenced and used as playground.
LPA observed a fully charged 2A10BC fire extinguisher last time serviced on February 2/17/21, and at least one working smoke detector. LPA observed the home has a working carbon monoxide detector. LPA observed there are not stairs or fireplace 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 showed she and her helper have immunization for measles, pertussis and influenza and their documents are in their personnel file.
************************Report dated 09/01/21 continues in page 2.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2021
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: NAVARRO, MARIA
FACILITY NUMBER: 274404704
VISIT DATE: 09/01/2021
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Report dated 09/01/21 continues from page 1.

A review of staff records on 8/31/21 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). The Licensee states that she does not transport 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 and her helpers Liset and Jesus have renewed the Mandated Reporter Training on 10/16/2019. Licensee was reminded the mandated reporter training is to be renewed every two years. LPA referred the Licensee to the Department website: www.ccld.ca.gov 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.

There were no deficiencies cited during today's inspection. Licensee rights was printed and handed to Licensee. Exit interview was conducted with licensee in Spanish.

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: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
LIC809 (FAS) - (06/04)
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