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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274414546
Report Date: 11/14/2024
Date Signed: 11/14/2024 01:43:03 PM

Document Has Been Signed on 11/14/2024 01:43 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:MEZA, MARIAFACILITY NUMBER:
274414546
ADMINISTRATOR/
DIRECTOR:		MEZA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 760-6482
CITY:SOLEDADSTATE: CAZIP CODE:
93960
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 9DATE:
11/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Maria MezaTIME VISIT/
INSPECTION COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Martha Jimenez-Villanueva met with licensee Maria Meza for an unannounced annual/random inspection. LPA explained the nature of today’s inspection. Licensee was present with her helper and nine children in care: 4 infants and 5 toddlers. All required posting materials were posted. Licensee stated days and hours of operation are Monday to Friday from 5:30AM to 4:30PM. Per licensee, adults residing in the home are licensee and her daughter. Licensee stated her two children ages sixteen and fourteen are also living in the home. The home is a one story home with four (4) bedrooms and two (2) bathrooms.

A review of staff records on 11/06/2024 indicates that not all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Ayleen Chairez Meza (licensee’s daughter) does not have fingerprint clearance. Licensee stated her daughter lives in the home and brother did not live at home but he will be completed his background check. 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 obtained a copy of current children's roster. Fire/disaster drill was conducted on November 12, 2024. LPA observed a fully charged 2A10BC fire extinguisher that was serviced on 11/05/2024, functioning smoke and carbon monoxide detectors, covered fireplace, no bodies of water, no stairs, fenced hallway, kitchen and backyard. Licensee stated no weapons in the home. LPA observed a dog in the backyard, licensee stated the dog is vaccinated.

LPA toured the indoor and outdoor areas of the home during today's inspection. Off limit areas in the home are four bedrooms, one bathroom, garage, backyard and left side yard. The home is clean, orderly, including central heating for safety and comfort for children in care. Cleaning products, sharp objects, and other items that are dangerous to children were stored inaccessible in the top cabinet in the kitchen. LPA observed sufficient age-appropriate materials, toys, and play equipment in the home. The children's bathroom is clean, sanitary, and operable. The home has a working telephone in the home.
Report continues in LIC 809-C page 2
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MEZA, MARIA
FACILITY NUMBER: 274414546
VISIT DATE: 11/14/2024
NARRATIVE
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LIC 809-C page 2
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

LPA reviewed nine (9) children's files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Immunization records, including Individual Infant Sleep Plan (LIC9227) and current sleep log for infants in care. All required forms are on file. The facility has a current liability insurance with ACORD.

LPA reviewed licensee and licensee's helper files. Licensee and helper have current Pediatric CPR/1st Aid with expiration dates February 2025 and February 2026 respectively. LPA observed the Licensee and helper have Mandated Reporter training completed on 01/23/2023 and 02/03/2024 respectively. Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is on file. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years.

Supervision of children was discussed with licensee, and she understands that she must be present in the home during day care hours (80% of the operating hours) and ensure that the children are supervised at all times. Licensee understands her capacity options and she understand that she cannot have more than 14 children in the home at any time. Licensee stated that a child will be isolated in the hallway area if necessary due to illness or communicable disease. Licensee stated that she does not transport day care children. LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size and car seats shall not be used for sleeping.

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.

Report continues in LIC 809-C page 3.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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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: MEZA, MARIA
FACILITY NUMBER: 274414546
VISIT DATE: 11/14/2024
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LIC 809-C page 3.
Licensee is not providing IMS at this time. 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: https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process

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



The following type B deficiency was cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Maria Meza.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/14/2024 01:43 PM - It Cannot Be Edited


Created By: Martha Jimenez-Villanueva On 11/14/2024 at 12:55 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: MEZA, MARIA
FACILITY NUMBER: 274414546

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in Ayleen Chairez Meza (licensee’s daughter) does not have fingerprint clearance. Licensee stated her daughter lives in the home which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/15/2024
Plan of Correction
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Licensee's daughter will submit proof that her daughter has completed the live scan process by the end of business day of 11/15/2024 to SJRO.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Susy Cervantes
LICENSING EVALUATOR NAME:Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


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