Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274450199
Report Date: 08/17/2018
Date Signed 08/17/2018 10:52:43 AM

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: 9DATE:
08/17/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Natividad RiosTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual random inspection to the home today. LPA met with Natividad Rios, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM. The adults that reside in the home are the Licensee, her spouse Rodrigo, her son Rodrigo and her daughter Marissa. There were nine children in care during today's inspection, included four infants, and five preschooler. Licensee's husband and helper (Rodrigo) was also present today during the inspection. Certification for CPR and First Aid Card for Licensee and her helper are current and will expire on 01/02/2020 for both.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the children's roster today and it is current. LPA randomly reviewed five children files and observed files are complete. LPA observed that Licensee has conducted a fire drill during the last six months. Last fire drill was documented on 4/09/2018.

The Licensee has a working telephone in the home (land line). LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: All the second floor, the laundry room, and the attached garage. Off limits areas outside: The left side yard. The home has a back yard and it is fenced, Licensee uses it as playground.
LPA observed a fully charged 3A40BC fire extinguisher and at least one working smoke detector. LPA observed the home has a carbon monoxide detector. LPA observed there are barricaded stairs in the home. Licensee stated she does not have pets. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.

Report dated 08/17/2018 continues in page 2.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2018
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: RIOS, NATIVIDAD
FACILITY NUMBER: 274450199
VISIT DATE: 08/17/2018
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Report dated 08/17/2018 continues from page 1.

LPA discussed Incidental Medical Services with licensee. According with the SB792, Licensee presented proof that she has immunization for herself and her husband for measles, pertussis and influenza and proof is in her personnel file.
A review of staff records on 08/16/2018 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.
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 14 children in the home at any time and a helper must be present. Licensee understands in absence of a helper the capacity of her license is reduced in capacity and ratio to a small Family Child Care Home license (maximum 8). The Licensee states that she does not transport children via vehicle and that she understands that children cannot be left in parked vehicles unattended at any time. Licensee uses redirection and communication with children as a form of discipline.
Department website: www.ccld.ca.gov provided to Licensee.
LPA discussed the requirements of AB 633 whenever a Type A deficiency is cited. LPA also discussed "zero tolerance" related regulations with the Licensee.
LPA observed that the Licensee has taken the required "mandated reporter" training that all Licensees will be required to complete starting January 1, 2018. Licensee and her helper Rodrigo have taken the training on 2/17/2018. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information on the online training.
There were not deficiencies cited during today's inspection. Appeal rights was printed and given to Licensee. Exit interview was conducted with licensee in Spanish.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2018
LIC809 (FAS) - (06/04)
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