444415945-2-19-2025-07-CC-TTRO-DE2UDF-20250219142927

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444415945
Report Date: 02/14/2025
Date Signed: 02/19/2025 02:29:40 PM

Document Has Been Signed on 02/19/2025 02:29 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	VASQUEZ-NAREZ, ANA MARIA		FACILITY NUMBER:	444415945
ADMINISTRATOR/ DIRECTOR:	ANA MONTES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 254-7878
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 4	DATE:	02/14/2025
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:00 PM
MET WITH:	Brenda Coronel del Cas		TIME VISIT/ INSPECTION COMPLETED:	02:45 PM

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On 02/14/25 at 11:45 AM, Licensing Program Analyst (LPA) Teodoro Trujillo met with assistant Brenda Castillo, for an annual inspection, licensee was not home. Present with assistant were 4 children: Three (3) preschool age, one Infant, licensee and her 16-, 10- and 7-year-old children arrived during site visit. Adults living in the home are licensee, with three minor children ages 16, 10 and 7 years old. Days and hours of operation are Monday through Friday 06:00 AM to 06:00 PM.
A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 02/13/25 was reviewed and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. Licensee Ana Vasquez Narez was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA inspected inside and outside of the two-story duplex home. Licensee rents the home and Licensee states she does not have liability insurance for a family childcare home (FCCH), LPA observed LIC282 on file. LPA observed a 3A40BC fire extinguisher last serviced on 08/06/24. Carbon Monoxide and smoke detectors are operable. LPA observed no wall heaters or fireplaces in the home. LPA observed barricaded stairs in the home. Licensee stated there are no firearms/weapons in the home. Sharp objects, medicines, poisons, and cleaning supplies are inaccessible to the children. Backyard is fenced. Off limits indoor: all of second floor bedrooms that include master bedroom with master bathroom and two bedrooms. Off Limit outdoor: outside front storage shed, and front entrance area. Licensee states there are no pets in the home.

Children were supervised during the visit and LPA went over substitute options and reminded licensee they could only have 14 children according to her license. Licensee states she does transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.

Continues report dated 02/14/2025 pg. 1/3.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025

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 02/19/2025 02:29 PM - It Cannot Be Edited

Created By: Teodoro Trujillo On 02/14/2025 at 01:43 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: VASQUEZ-NAREZ, ANA MARIA	FACILITY NUMBER: 444415945
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(g)(1)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in Child 2 (C2) and Child 4 do not have CDPH 286 Immunizaiton record completed which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2025
	Plan of Correction
1 2 3 4	Licensee will submit a copy of completed CDPH 286 for C2 and C4 to the San Jose Regional Office by close of business 02/28/25.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Susy Cervantes

LICENSING EVALUATOR NAME:

Teodoro Trujillo

LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: VASQUEZ-NAREZ, ANA MARIA	FACILITY NUMBER: 444415945
	VISIT DATE: 02/14/2025

NARRATIVE

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Continuation of report dated 02/14/2025 pg. 2/3.

LPA observed a current roster of the children. LPA observed a fire and disaster drill log last performed on 02/10/2025. LPA reviewed 6 children’s files and observed all required documentation was not in compliance. Child 2 (C2) and C4 have missing CDPH 286 Immunization Form missing. Infant individual sleeping plan (LIC 9227) for each infant under 12 months was discussed. LPA observed licensee completed Mandated Reporter Training on 05/08/24 and assistant on 6/13/24. Licensee has Pediatric CPR/1^st Aid expiring on 05/05/2026 and assistant on 8/28/26. Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is current for licensee, and all adults residing in the home.

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 currently. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

LPA discussed the safe sleep regulations with licensee Ana Vasquez Narez and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee Ana 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 may 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 CARE tools, please send email inquiries 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/inspection-process.

Continues report dated 02/14/2025 pg. 2/3.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: VASQUEZ-NAREZ, ANA MARIA	FACILITY NUMBER: 444415945
	VISIT DATE: 02/14/2025

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Continuation of report dated 02/14/2025 pg. 3/3.
Licensee Ana Vasquez Narez was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Ana Vasquez Narez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Type B Deficiencies were cited today. 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.

Exit interview conducted and report was reviewed with the licensee Ana Vasquez Narez.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025

LIC809 (FAS) - (06/04)

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