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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444414391
Report Date: 04/13/2023
Date Signed: 04/18/2023 08:27:46 AM

Document Has Been Signed on 04/18/2023 08:27 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:ESPINO, GLORIA ALEJANDRAFACILITY NUMBER:
444414391
ADMINISTRATOR:ESPINO, GLORIA ALEJANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 254-0765
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 1CENSUS: 1DATE:
04/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Gloria Alejandra EspinoTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Gloria Alejandra Espino for an unannounced Required – 1 year annual inspection. Upon arrival, Licensee was heading out to pick up her son who missed the bus. LPA waited outside for Licensee to return. The Licensee states that she currently is not caring for children and will begin on May 29, 2023. Days and hours of operation will be Monday - Saturday from 6:00 AM to 6:00 PM. There are four adults living in the home, Licensee, her husband (Leopoldo Rebollar) , adult daughter, Cynthia Rebollar Espino and adult son, Luis Rebollar Espino. Licensee has 9 year old son.

Child Care Facility Roster was reviewed today during today's inspection. Licensee has day care insurance with Markel Insurance. Licensee has current CPR and First Aid certifications expiring on May 8, 2023. Licensee has the required vaccines (MMR, Tdap) and influenza. Licensee is current with her Mandated Reporter Training for Child Care Workers which expires on April 20, 2024. LPA reviewed Licensee's file. File was complete with the required forms and immunization records.
LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (831) 254-0765. The home is clean, orderly, (including proper heating/cooling/ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. Off limit areas inside the home: four bed rooms and garage. The backyard is off limits. Licensee uses the right side patio for day care. LPA observed a fully charged 3A40BC fire extinguisher which was serviced on March 2023. The smoke/carbon monoxide detectors were tested and proved to be functioning.
No bodies of water were observed. Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Licensee understands that poisons are to be locked. Licensee has two pet dogs and are kept off limit.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
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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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: ESPINO, GLORIA ALEJANDRA
FACILITY NUMBER: 444414391
VISIT DATE: 04/13/2023
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Licensee states that she provides breakfast, snack, lunch, and PM snack. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored. Licensee has a first aid kit in the home which includes a touch less thermometer. Licensee states that no one smokes in the home. Licensee understands that smoking is prohibited in the home.

Licensee states that she will administer any medications to the day care children. 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

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. Licensee understands the capacity/ratio options. Licensee states that a child will be isolated in the living room area if necessary due to illness or communicable disease. Licensee states that she does not transport any day care children. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

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 discussed the safe sleep regulations with the Licensee, Gloria Alejandra Espino and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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.

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

An exit interview was conducted with Licensee.

NO DEFICIENCY CITED.

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: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
LIC809 (FAS) - (06/04)
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