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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415956
Report Date: 11/07/2024
Date Signed: 11/07/2024 01:17:50 PM

Document Has Been Signed on 11/07/2024 01:17 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:BECERRA, YECENIAFACILITY NUMBER:
274415956
ADMINISTRATOR/
DIRECTOR:		YECENIA BECERRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 737-7305
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
11/07/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Yecenia BecerraTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Martha Jimenez-Villanueva met with licensee Yecenia Becerra for an unannounced annual/random inspection. LPA explained the nature of today’s inspection. Licensee was present with three (3) daycare children: 1 infant, 1 toddler and 1 schooler in care. All required posting materials were posted. Licensee stated days and hours of operation are Monday to Saturday from 5:30AM to 6:00PM. Per licensee, adults residing in the home are licensee and her husband. Licensee stated her 17-year-old daughter, 12 year old son and 9 year old daughter are also residing in the home. LPA reminded licensee that children living in the home who turn 18-year-old have 30 days to obtain fingerprint clearances and TB test. The home is a two story home with four (4) bedrooms and two (3) bathrooms.

A review of staff records on 11/04/2024 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, 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 August 1, 2024. LPA observed a fully charged 3A40BC fire extinguisher that was serviced on 08/29/2024, functioning smoke and carbon monoxide detectors, glass covered fireplace, barricaded stairs, no bodies of water, and fenced backyard. Licensee stated that there are no weapons or firearms in the home. LPA observed a dog, licensee stated is vaccinated. The playground area is located in backyard of the house.

Report continues in LIC 809-C page 2
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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: BECERRA, YECENIA
FACILITY NUMBER: 274415956
VISIT DATE: 11/07/2024
NARRATIVE
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LIC 809-C page 2

LPA toured the indoor and outdoor areas of the home with the Licensee during today's inspection. Off limit areas inside the home are the entire second floor, laundry room, hallway closet and attached garage in the first floor. The home is clean, orderly, (including heating/air conditioning) for safety and comfort for children in care. Cleaning products, sharp objects, and other items that are dangerous to children were stored inaccessible. 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. Off limit areas outside the home: front yard, porch and right and left side yards.

LPA reviewed six (6) children's files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Affidavit Regarding Liability Insurance (LIC 282), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Immunization records and Individual Infant Sleeping Plan (LIC 9227) and current sleep log (for children 0-24 months). All required forms are on file exempting Child (1 & 2), missing CDPH 286 on file.

LPA reviewed licensee and helper’s file. Licensee and her helper have current Pediatric CPR/1st Aid with expiration date 03/05/2026 both of them. Licensee and her helper have Mandated Reporter training completed on 12/06/2022 and 01/27/2023 respectively. Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is on file for licensee and helper. 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 living room area if necessary due to illness or communicable disease. Licensee stated that she transports 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.



Report continues in LIC 809-C page 3.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
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: BECERRA, YECENIA
FACILITY NUMBER: 274415956
VISIT DATE: 11/07/2024
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LIC 809-C page 3.

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.

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

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 YECENIA BECERRA 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 deficiency 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 Yecenia Becerra in Spanish.

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

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
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Document Has Been Signed on 11/07/2024 01:17 PM - It Cannot Be Edited


Created By: Martha Jimenez-Villanueva On 11/07/2024 at 12:36 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: BECERRA, YECENIA
FACILITY NUMBER: 274415956

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in Child (1 & 2), missing CDPH 286 on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/21/2024
Plan of Correction
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By 11/21/2024, Licensee agreed to submit proof of CDPH 286 for Child (1 & 2) by the end of the business day of the due date of this POC to CCLD.
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: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2024


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