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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444407225
Report Date: 09/29/2021
Date Signed: 09/30/2021 01:29:13 PM

Document Has Been Signed on 09/30/2021 01:29 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:VARGAS, MARIAFACILITY NUMBER:
444407225
ADMINISTRATOR:VARGAS, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 274-2350
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maria VargasTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Maria Vargas for an unannounced Required – 1 year annual inspection (KIT 2). LPA was granted access to the home by the Licensee's adult daughter, Araceli Vargas. LPA also observed 8 day care children (3 infants 5 preschool age children) License's grandchildren ages 4 and 8. Licensee's granddaughter; Cynthia Loera; Licensee's husband Armando Vargas.
Janessa and Cynthia are helping with day care children.

The Licensee is operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM.
The adults that reside in the home are Licensee, Licensee's husband (Armando Vargas) and her granddaughter (Cynthia Loera).

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. LPA observed that the roster was missing three children; LPA reminded Maria that the roster needs to be updated and up to date.

The last fire/disaster drill was completed on 02/14/2020. The Licensee and assistants have the required vaccinations (MMR, Tdap, flu). Licensee's Mandated Reporter Training is valid until January 8, 2022 and Cynthia and Araceli's are valid until 01/25/2022. Licensee's CPR and First Aid are current and expire on 06/17/2022. Cynthia's CPR & First Aid expire on 01/2022. Araceli's CPR & First Aid expire on 06/17/2022.

Safe sleep update: LPA discussed the new “Safe Sleep” regulations with the Licensee and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensee. LPA reminded the Licensee that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.

LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. Licensee provided her cell phone (831) 331-3367 LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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: VARGAS, MARIA
FACILITY NUMBER: 444407225
VISIT DATE: 09/29/2021
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 Off limit areas in the home are: three bedrooms, and bathroom, located in hallway. Off limit areas outside the home: detached garage, fenced areas behind yard, and both side yards.
LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. The Licensee states that she does not have any weapons in the home. Licensee has two pet dogs.
All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Any poisons are locked and inaccessible to the day care children. The Licensee states that she does not administer any medication to the day care children at this time.
A review of staff records on September 21, 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.
Licensee states her granddaughter's boyfriend, Andrew Raufman is waiting for fingerprint clearance and does not live in the home.
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 8 children in the home at any time. The Licensee states that does not transport any day care children. The 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.
LPA conducted an exit interview with the Licensee and advised her that no deficiencies issued during today's inspection.
A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/30/2021 01:29 PM - It Cannot Be Edited


Created By: Elizabeth Berumen On 09/29/2021 at 01:11 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: VARGAS, MARIA
FACILITY NUMBER: 444407225

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2021
Section Cited
CCR
102417(g)(9)(A)(1)

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Operation of a Family Child Care Home - Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1) The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
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Licensee agrees to practice a fire drill with the children and will submit documentation by October 6, 2021.
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This requirement is not met as evidenced by: LPA observed that the last fire drill was conducted on February 14, 2020. This poses a potential risk to the health and safety to children in care.
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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:Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2021


LIC809 (FAS) - (06/04)
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