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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274450197
Report Date: 10/28/2021
Date Signed: 11/08/2021 11:45:04 AM

Document Has Been Signed on 11/08/2021 11:45 AM - 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:AYALA, OLGAFACILITY NUMBER:
274450197
ADMINISTRATOR:OLGA AYALAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 536-5077
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Olga AyalaTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Olga Ayala for an annual inspection and explained the reason for the visit to her. Present during today's visit were licensee, adult daughter/assistant (Jiselle), 6 day care children (1 infant and 5 preschoolers). Licensee's adult daughter (Mary Magana Ayala) was also present during the inspection and not assisting with children. Adult's living in the home are: Licensee, two adults daughters, two tenants (Mario Salvador Bruno and Enedina Cruz Lopez) and licensee's boyfriend (Jose Santiago-Flores). Two minor children live in converted garage with their parents.

A review of staff records on October 28, 2021 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 the 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.

LPA inspected inside and outside of the home. Licensee stated there are no weapons in the home. Licensee has two pet dogs. LPA observed a 3A40BC fire extinguisher. LPA tested the Carbon Monoxide/smoke detector and proved to be functioning. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children. Licensee understands that poisons are to be locked. Licensee uses the front left side of backyard as outdoor play space. The area is fenced and safe for the children. The off limit areas inside the home are: basement and garage. LPA notes that basement and garage are in lower level of the home. The garage is converted into a living quarters where two tenants live (Mario Salvador Bruno and Enedina Cruz Lopez) and there two minor children (3 years old and 11 months). The stairs leading to the area are barricaded. Three bedrooms and two hall closets are off limits. Entire backyard is off limits to children. Children were supervised during the visit and LPA went over substitute options and reminded licensee they could only have 14 children according to their license with a qualified assistant. Licensee states she does not transport children in her vehicle. Licensee understands that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.
Report continues on 809C
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2021
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: AYALA, OLGA
FACILITY NUMBER: 274450197
VISIT DATE: 10/28/2021
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LPA reviewed Licensee's and assistants file. Licensee has current CPR & First Aid expiring on 02/03/2023. Licensee completed mandated reporter, AB1207 compliant on 08/17/2021. Licensee understands the course it to be renewed every two years. Licensee has immunization's against pertussis, measles and influenza.

LPA discussed Lead Safety Information (AB 2370). Chapter 676, statues of 2018, requires all child care providers, upon enrolling or re-enrolling any child, to provide the parent or guardian with written information. LPA emailed the flyer to Olgaayala215@yahoo.com. Olga agrees to print flyer and provide to parents.

Safe Sleep was discussed: place infants on their backs when sleeping, use a firm sleep surface such as a mattress in a safety approved crib, keep soft bedding such as blankets, pillows, toys out baby's sleep area and ensure that pacifiers have nothing attached to them. LPA discussed the requirement of the Individual Infant Sleeping Plan (LIC 9227) and the requirement to monitor infants every 15 minutes while sleeping. LPA reviewed infant file and observed that infant has the LIC 9227 on file and sleep check on file.

LPA discussed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, etc.

Licensee updated the LIC 279 and LIC 279 B during today's inspection.

Exit Interview was conducted. No deficiency cited.

A copy of this report was provided to the Licensee at the conclusion of the inspection.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC809 (FAS) - (06/04)
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