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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274450010
Report Date: 07/21/2021
Date Signed: 07/21/2021 02:13:31 PM

Document Has Been Signed on 07/21/2021 02:13 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:RODRIGUEZ, IRMAFACILITY NUMBER:
274450010
ADMINISTRATOR:IRMA RODRIGUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 757-4583
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
07/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Irma RodriguezTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced one year required inspection to the home today. LPA met with Irma Rodriguez, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 6:30 AM to 5:30 PM. The adults that reside in the home are the Licensee, her spouse Pedro, and her son Luis. LPA observed that Licensee's son Luis was present and helping the Licensee during today's inspection. There were 10 children in care present during today's inspection, included 3 infants, 3 school age, and 4 preschool children. Licensee's certifications for CPR and First Aid card is current and will expire on 1/11/2022 for herself and on 5/17/22 for her helper Luis.
LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the Child Care Facility Roster during today's inspection and it is current. 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. LPA reviewed the Fire/Disaster drill log during today's visit and it is current. Last fire drill was documented on 07/01/21.
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 in the home are: 3 bedrooms, 1 bathroom, the living room, and the attached garage.. LPA observed that the laundry room is located inside the attached garage. LPA observed there are not stairs in the home and a barricaded fireplace in the off limits living room. The off limits area outside the home is the right side yard. LPA observed the home has a back yard and it is fenced. Licensee uses the back yard as playground whenever the weather allows it. LPA observed a fully charged 2A10BC fire extinguisher last time service4d on 6/01/21, working smoke detectors and no bodies of water. LPA observed the home has a working carbon monoxide detector. 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 (IMS) with the Licensee.

Report dated 07/21/21 continues in page 2.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2021
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: RODRIGUEZ, IRMA
FACILITY NUMBER: 274450010
VISIT DATE: 07/21/2021
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Report dated 07/21/21 continues from page 1.
Licensee has in file proof of immunization for influenza, pertussis and measles for herself, and her helpers according with the SB792.
A review of staff records on 07/16/21 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 that in absence of a helper her license capacity is reduced to only 8 children and ratio (age of the children) shall be observed as well. The 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: www.ccld.ca.gov provided to Licensee.
LPA discussed the requirements of AB 633 with the Licensee. LPA also discussed "zero tolerance" related regulations with the Licensee. LPA observed that the Licensee has proof of completion of the required "mandated reporter" on 3/12/21 and her helper on 9/26/19. Licensee understands that her helpers and all the adults in contact with children are required to complete the same training. 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.
No deficiencies were cited during today's inspection. Licensee rights form was printed and given 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: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC809 (FAS) - (06/04)
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