Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274450199
Report Date: 08/28/2015 12:00:00 AM
Date Signed 08/28/2015 12:23:25 PM

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:RIOS, NATIVIDADFACILITY NUMBER:
274450199
ADMINISTRATOR:NATIVIDAD RIOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 442-0970
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY:14CENSUS: 7DATE:
08/28/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Natividad RiosTIME COMPLETED:
12:40 PM
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(3) Licensing Program Analyst (LPA) Maria Mercado conducted an unannounced random visit to the home today. LPA met with Licensee and explained the nature of today's visit to her. LPA observed Licensee with six day care children and one grandchild (5 pre-school, 2 infants) in the home during today's visit. Days and hours of operation are Monday - Friday from 6 AM to 6 PM. The adults that reside in the home are the Licensee and spouse. Licensee's spouse, Rodrigo, arrived shortly after visit began. Licensee's and Rodrigo's certifications for CPR/First Aid are current and expire on 02/17/17. LPA conducted visit in Spanish.

LPA toured the indoor and outdoor areas of the home during today's visit. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's visit. LPA reviewed seven children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights form (LIC 995A) in each file. The Licensee has a working telephone in the home. 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. LPA did not observe any wall heaters inside the home. Off limit areas in the home upstairs: 4 bedroom/ 2 bathrooms, downstairs: laundry room, garage, 1 barricaded fireplace (located in the living room), and garage with laundry area. The stairs are barricaded. the home. Off limit areas outside the home: the right and lefts sides of the yard that are both barricaded. LPA observed a fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee states that she does not have any weapons in the home. Knives are inaccessible. All detergents, cleaning compounds and other similar items are stored and inaccessible to children. There are no poisons in the home. Medications are in master bedroom.

LPA discussed the new Incidental Medical Services procedures. Licensee states she does not have any medication for any of the children and understands she must submit a plan to Licensing if she plans to give Incidental Medical Services in the future.
REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #1 - REPORT DATED 08/28/2015
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Maria MercadoTELEPHONE: (408) 334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2015
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2


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: RIOS, NATIVIDAD
FACILITY NUMBER: 274450199
VISIT DATE: 08/28/2015
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 08/28/2015):

A review of staff records on 08/27/15 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 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 discussed Unusual Incident/Injury Report, The Car Seat Law, Healthy Beverages Act and informed Licensee that smoking is not allowed when day care children are present. LPA discussed with Licensee children are not to be left in parked vehicles.

LPA reminded Licensee of the license limitations: MAX. CAP (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6. When only 1 adult is present, the license automatically reverts to a Small FCCH of : MAX. CAP: 6 - NO MORE THAN 3 INFANTS OR 4 INFANTS ONLY. CAP. 8 - NO MORE THAN 2 INFANTS, 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

There are no deficiencies cited today.

NOTICE OF CITE VISIT WAS ISSUED AND POSTED NEAR THE FRONT ENTRANCE FOR 30 DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Maria MercadoTELEPHONE: (408) 334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2015
LIC809 (FAS) - (06/04)
Page: 2 of 2