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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444415553
Report Date: 06/17/2021
Date Signed: 06/18/2021 07:52:10 AM

Document Has Been Signed on 06/18/2021 07:52 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:SOTELO, ERIKAFACILITY NUMBER:
444415553
ADMINISTRATOR:SOTELO, ERIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 740-9530
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
06/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Erika SoteloTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with licensee, Erika Sotelo for a Required 1 year inspection. LPA explained the nature of today’s visit. Present during today’s visit were Licensee, Licensee's daughter, Jasmine Rocha-Sotelo and 5 preschool age children. Licensee states there are 5 adults living in the home and her two grandchildren ages 3 and 9 years old.
Days and hours of operation are Monday through Friday, 6:00 am to 6:00 pm.

A review of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 06/17/2021 was reviewed and it indicates that not all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. Licensee states she hired, Gloria Alvarez Arizmen #7517539525 last year. LPA notes that Gloria Alvarez Arizmen is not presnt today. LPA informed licensee that Gloria's criminal record clearances are not cleared.
LPA toured the inside and outside of the home. The off limit areas inside the home are two bedrooms, two hall closets and laundry room. The home is clean and orderly. The laundry room entrance is located in the backyard. The off limit area in the backyard is the storage shed. There is a fence on left side of the yard that prevents children from accessing the storage shed. Left fenced side of backyard is off limits to children.
Licensee states there are no firearms/weapons in the home. Licensee has a pet dog who is kept in off limit area of the backyard. LPA observed a 3A40BC fire extinguisher; fire and carbon monoxide detectors were tested and proved to be functioning. Telephone is in working order; Licensee provided her home telephone number (831)536-5327. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children.
(report dates 06/17/2021 continues on next page 809c)
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2021
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: SOTELO, ERIKA
FACILITY NUMBER: 444415553
VISIT DATE: 06/17/2021
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LPA reminded licensee that she can only have 14 children according to her license. She understands her capacity options and ratio. Children were supervised during the visit and LPA went over substitute options. Licensee stated that she does not transport children. LPA reminded Licensee that children are not to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size. LPA reviewed facility roster. Roster is up to date. LPA observed a fire and disaster drill log. LPA reviewed 5 children’s files and observed a copy of the emergency information card (LIC 700) in each file. No infant files were reviewed. LPA observed that the Licensee has completed Mandated Reporter training. LPA reminded Licensee that course is to be renewed every two years. Licensee has current Pediatric CPR/1st Aid expiring on 09/12/2022. Licensee has immunization's against pertussis, measles and influenza. Licensee has a TB in her file.

Incidental Medical Services (IMS) policy was discussed with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing IMS at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.
Licensee was reminded that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. LPA discussed the immediate civil penalties for Zero Tolerance of $500 and the Healthy Beverage Act and AB633 requirements for type A violation. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. Safe sleep was discussed with the Licensee and Guide to Safe Sleep information was provided to the licensee. Department website: http://ccld.ca.gov provided to Licensee. Licensee states she does have 2 infants enrolled but are not present today. LPA reviewed there files and both have the infant sleeping plans in file.
Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made. email erikasotelo710@gmail.com
An exit interview was conducted with Licensee in Spanish. No deficiencies were cited during today’s inspection
Notice of site visit must remain posted for 30 days.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
LIC809 (FAS) - (06/04)
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