274450016-5-25-2022-07-CC-FCJO-CERU4M-20220525151524

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274450016
Report Date: 05/25/2022
Date Signed: 05/25/2022 03:15:34 PM

Document Has Been Signed on 05/25/2022 03:15 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:	VALENZUELA, BERTHA		FACILITY NUMBER:	274450016
ADMINISTRATOR:	BERTHA VALENZUELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 710-5422
CITY:	CASTROVILLE	STATE: CA	ZIP CODE:	95012
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 7	DATE:	05/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Bertha Valenzuela		TIME COMPLETED:	03:30 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 Bertha Valenzuela, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday - Saturday from 6:00 AM to 6:000 PM. The adults that reside in the home are the Licensee, her spouse Jose, and her adult son David. LPA observed seven children present and in care during today's inspection, included two preschool age and five school age. Licensees' certifications for CPR and First Aid have expired on 05/05/2020. LPA toured the indoor and outdoor areas of the home during today's inspection. LPAs reviewed the Child Care Facility Roster during today's inspection and it is current. LPAs reviewed the Fire/Disaster drill log during today's visit and it is current. Last fire drill was documented on 4/01/22. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. LPA observed there are not wall heaters in the home. Off limit areas in the home are the 3 bedrooms, and 1 bathroom. LPA observed there are no stairs in the home. Off limits out side is a locked shed located in front yard and the left side yard where the Licensee keeps a small dog. Licensee stated the dog is vaccinated. Licensee also has a adult cat living in the home. LPAs observed the home has a back yard and it is fenced. Licensee uses the back yard as playground. LPA observed a fully charged 2A10BC fire extinguisher, working smoke detectors and no bodies of water. LPA observed a working carbon monoxide detector in the home. 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. LPA observed Licensee has submitted proof of immunization for herself and for her husband for pertussis, measles and influenza. Report dated 05/25/22 continues in page 2.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

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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Document Has Been Signed on 05/25/2022 03:15 PM - It Cannot Be Edited

Created By: Fermin Campos-Jaramillo On 05/25/2022 at 02:23 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: VALENZUELA, BERTHA	FACILITY NUMBER: 274450016
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records review, the licensee did not comply with the section cited above in 2 out of 2 persons (licensee and her helper and spouse), which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/15/2022
	Plan of Correction
1 2 3 4	Licensee and her helper Jose shall complete the Mandated Reporter training and will submit a copy to Licensing Program on or before June 15, 2022.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. 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 2 out of 2 persons licensee and her helper, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/15/2022
	Plan of Correction
1 2 3 4	Licensee shall renew the in person pediatric CPR for herself and for her helper and will submit a copy to licensing Program on or before June 15, 2022.

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: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

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: VALENZUELA, BERTHA	FACILITY NUMBER: 274450016
	VISIT DATE: 05/25/2022

NARRATIVE

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Report dated 5/25/22 continues from page 1.

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. 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. LPAs also discussed "zero tolerance" related regulations with the Licensee. LPA observed that licensee has not completed the required "mandated reporter" training for herself and for her husband and helper. Licensee understands the training must be renewed every two years. LPA referred the licensee to the training website www.mandatedreporterca.com for additional information.

A review of staff records on 5/24/22 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.

Licensee Bertha Valenzuela 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 5/25/22 continues on page 3.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

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: VALENZUELA, BERTHA	FACILITY NUMBER: 274450016
	VISIT DATE: 05/25/2022

NARRATIVE

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Report dated 5/25/22 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 Bertha Valenzuela.

Two type B deficiencies were cited today.

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

Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

LIC809 (FAS) - (06/04)

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