274415981-6-13-2023-07-CC-FCJO-CSS2D6-20230613171748

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274415981
Report Date: 06/13/2023
Date Signed: 06/13/2023 05:17:56 PM

Document Has Been Signed on 06/13/2023 05:17 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	BONILLA, ZOILA		FACILITY NUMBER:	274415981
ADMINISTRATOR:	ZOILA BONILLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 521-5583
CITY:	SEASIDE	STATE: CA	ZIP CODE:	93955
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 15	CENSUS: 10	DATE:	06/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Zoila Bonilla		TIME COMPLETED:	05:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA) Fermin Campos-Jaramillo conducted an unannounced annual inspection to the home today. LPA met with Zoila Bonilla, 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 and her adult daughter Estrella. There were 10 children in care during today's inspection included two infants, one school age, and seven preschoolers. Also in the home reside licensee's minor child 14 years old. Certification for CPR and First Aid Card for Licensee and her helper Estrella are current and will expire on 1/07/25 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. LPA observed that Licensee has conducted a fire drill during the last six months. Last fire drill was documented on 2/16/23. LPA reviewed five children files and are complete including the parent's rights form and the immunization records form. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: 3 bedrooms, one bathroom, and the laundry/storage area. Off limits areas outside: A small section of the back yard where licensee has a storage shed. The home has a back yard and it is fenced. LPA observed a fully charged 3A40BC fire extinguisher last time serviced on 1/25/23, and at least one working smoke detector. LPA observed the home has a carbon monoxide detector. LPA observed there are not stairs or bodies of water in the home. LPA observed there is a fish tank in the on limits area, and it has a lid that totally covers the top of it, and it is unreachable by the children in care. LPA observed the tank seats on top of a wood chest. LPA observed the home has in the on limits area an electric fireplace barricaded with a glass screen. Licensee stated she turns it on only on cold days before the children arrive. LPA observed the home has a wall heater which has been barricaded with wood. Licensee stated the wall heater has been disabled previously to provide childcare. Licensee stated they do not have pets in the home. Licensee states that there are not weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. Report dated 6/13/23 continues in page 2.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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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Document Has Been Signed on 06/13/2023 05:17 PM - It Cannot Be Edited

Created By: Fermin Campos-Jaramillo On 06/13/2023 at 04:33 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: BONILLA, ZOILA	FACILITY NUMBER: 274415981
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(1)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in four persons. Licensee is not documenting the times she check on infants at sleep, for children ch1, ch2, ch3, ch4, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/27/2023
	Plan of Correction
1 2 3 4	Licensee shall start documenting every 15 minutes when infants sleep starting on 6/14/23 and until children reach the age of 2 years old. Licensee will submit to Licensing Program the log of documenting infants sleep for the children ch1, ch2. ch3, ch4 for the period 6/14 to 6/23/23 and will submit to licensing not later than 6/27/23.

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in two cases, Licensee has not obtained a signed lic9227 for two infants (ch 1, ch2) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/27/2023
	Plan of Correction
1 2 3 4	Licensee shall complete and obtain signed forms LIC9227 for infants ch1 and ch2. Licensee will submit to Licensing program copies of forms LIC9227 for those 2 infants not later than 6/27/23

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: 06/13/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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: BONILLA, ZOILA	FACILITY NUMBER: 274415981
	VISIT DATE: 06/13/2023

NARRATIVE

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Report dated 6/13/23 continues from page 1.

According with the SB792, Licensee has presented proof that she has immunization for herself and for her helpers for measles, pertussis and influenza.
Supervision of children was discussed with Licensee and she understands that she or qualified helpers must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands the capacity options and she understands that with a large license, she cannot have more than 14 children in the home at any time, a helper must be present, and ratio (age of the children) must be observed.. Licensee understands in absence of a helper her license is reduced in capacity and ratio to a small Family Child Care Home license (maximum 8). 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.
Department website: www.ccld.ca.gov provided to Licensee.

LPA observed that Licensee and her helper have renewed the "Mandated Reporter" training on 1/05/22 Licensee understands the training must be renewed every two years. LPA referred the Licensee to the Department website: www.mandatedreporterca.com for additional information on the online training.

A review of staff records on 6/06/23 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 Zoila Bonilla 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.

Report dated 6/13/23 continues on page 3.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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: BONILLA, ZOILA	FACILITY NUMBER: 274415981
	VISIT DATE: 06/13/2023

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Report dated 6/13/23 continuers from page 2.

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.

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 Zoila Bonilla.

Two type B deficiencies were cited today.

Failure to comply with the Plan Of Corrections (POC) by the due date on LIC809D shall result in an immediate civil penalty of $100 per day per each deficiency.

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: 06/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

LIC809 (FAS) - (06/04)

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