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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274405929
Report Date: 10/20/2022
Date Signed: 10/20/2022 01:24:18 PM

Document Has Been Signed on 10/20/2022 01:24 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:ALVAREZ, SANDRAFACILITY NUMBER:
274405929
ADMINISTRATOR:ALVAREZ, SANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 633-0609
CITY:CASTROVILLESTATE: CAZIP CODE:
95012
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 6DATE:
10/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Sandra AlvarezTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo met with licensee Sandra Alvarez for an unannounced annual required inspection. LPA explained the nature of today’s inspection to Sandra. LPA observed six children were in care included one infant and five preschool children during today’s inspection. Licensee's husband and helper Clemente was also present. Days and hours of operation are Monday to Friday, 5:00am to 7:00pm and Saturdays 5:00 AM to 3:00 PM. The adults that reside in the home are the licensee, licensee's husband Clemente, and her adult daughter Karina.

LPA toured the indoor and outdoor areas of the home during today’s visit. LPA observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPA observed no stairs inside the home. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items are stored inaccessible to children. LPA observed a fully charged 3A40BC fire extinguisher last time services on 4/13/22. LPA observed a working smoke detector and a working carbon monoxide detectors. Licensee states there are no weapons/firearms in the home.

Off limit areas indoor: Four bedrooms, two bathroom and the garage. LPA observed a fenced backyard and no bodies of water. LPA observed two off limits locked storage sheds in the backyard. Also off limits are the far back yard, the left side yard, and right side yards where the licensee keeps two small dogs. Licensee stated the dogs are vaccinated.

LPA observed licensee and her helper Clemente have a current training on preventive health practices, and have current CPR and First Aid certification expiring 11/20/23 for both licensee and her helper Clemente.

Report dated 10/20/22 continues in page 2.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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: ALVAREZ, SANDRA
FACILITY NUMBER: 274405929
VISIT DATE: 10/20/2022
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Report dated 10/20/22 continues from page 1.

LPA obtained a copy of the children's roster which is current. Licensee has documented a fire and disaster drill log on 9/23/22. LPA reviewed six children files and files are complete and include the Parent's rights form and the immunization records form. Supervision of children was discussed with 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 options and she understands that she cannot have more than 14 children in the home and a helper must be present at any time. Licensee understand that without a helper present her license capacity is reduced to only 8 children. Licensee states that she does not transport children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.
Department website: http://ccld.ca.gov provided to Licensee.
LPA observed licensee has proof of the required immunization for pertussis, measles and influenza for herself and for her helper Clemente. LPA observed licensee and her helper have renewed the Mandated Reporter training on 7/31/22. Licensee understands the training has to be renewed every two years. LPA provided licensee with the website www.mandatedreporterca.com for additional information.
A review of staff records on 10/18/22 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 Sandra 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 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 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.

Report dated 10/20/22 continues on page 3.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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: ALVAREZ, SANDRA
FACILITY NUMBER: 274405929
VISIT DATE: 10/20/2022
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Report dated 10/20/22 continues from page 2.

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

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 Sandra Alvarez.

No deficiencies were cited today.

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

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC809 (FAS) - (06/04)
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