Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444410144
Report Date: 06/14/2016
Date Signed 08/15/2016 02:26:06 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:CHAVEZ, ESTHERFACILITY NUMBER:
444410144
ADMINISTRATOR:ESTHER CHAVEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-8622
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 6DATE:
06/14/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Esther ChavezTIME COMPLETED:
04:00 PM
NARRATIVE
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(2) Licensing Program Analyst (LPA) Wendy Emery and Licensing Program Manager (LPM) Mary Segura conducted an unannounced random visit to the home today. LPA met with Esther Chavez, Licensee, and explained the nature of today's visit to her. LPA observed 1 adult assistant and 6 day care children (including 2 infant) in the home during today's visit. Days and hours of operation are Monday - Saturday from 6:00 AM to 6:00 PM. The adults that reside in the home are the Licensee and her spouse. Licensee's certifications for CPR and First Aid are current and expire 03/03/17.

LPA toured the indoor and outdoor areas of the home during today's visit. Licensee unable to provide the Child Care Facility Roster during today's visit. LPA reviewed the Fire/Disaster drill log during today's visit, last fire drill conducted 03/15/16. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, and orderly. Off limit areas in the home: 1 bedroom, attached garage. There are no stairs in the home. Off limit areas outside the home: right side yard and 2 locked storage shed.

LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detector, and no bodies of water. The Licensee states that she does not have any weapons in the home. LPA observed poisons/toxins in the attached garage which are accessible to children.

A review of staff records on 06/13/16 indicates that all 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.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (510) 286-0429
LICENSING EVALUATOR NAME: Wendy EmeryTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2016
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 4


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: CHAVEZ, ESTHER
FACILITY NUMBER: 444410144
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2016
Section Cited
102417(g)(8)
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102417(g)(8) Operation of a Family Child Care Home. All homes shall have a current roster of the children. Licensee unable to provide current roster during today's visit.
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Licensee to complete roster with current children enrolled. LPA advised licensee to maintain roster and update when children enroll and disenroll. Licensee to send copy of current roster to LPA by poc.
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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 SeguraTELEPHONE: (510) 286-0429
LICENSING EVALUATOR NAME: Wendy EmeryTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2016
LIC809 (FAS) - (06/04)
Page: 2 of 4


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: CHAVEZ, ESTHER
FACILITY NUMBER: 444410144
VISIT DATE: 06/14/2016
NARRATIVE
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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 with a qualified assistant present. The Licensee states that she does not transports children via vehicle but understands that children cannot be left in parked vehicles unattended at any time.

LPA discussed the requirements of AB 633 with the Licensee and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Licensee understands the requirements. LPA also discussed "zero tolerance" related regulations with the Licensee and advised her of the assessment of an immediate $150 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $150 per day continues until the violation(s) is corrected.

LPA conducted an exit interview with the Licensee prior to the conclusion of today's visit.

The following deficiencies are noted on the following page:

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

A notice of site visit was issued and posted near the facility entrance along with the Type "A" citation and both notices must remain posted for 30 consecutive days. The Licensee must provide copies of this report to parents/guardians of children in care at this facility and to parents/guardians of children newly enrolled at this facility during the next 12 months.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (510) 286-0429
LICENSING EVALUATOR NAME: Wendy EmeryTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2016
LIC809 (FAS) - (06/04)
Page: 3 of 4


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: CHAVEZ, ESTHER
FACILITY NUMBER: 444410144
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/15/2016
Section Cited
102417(g)(4)(A)
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102417(g)(4) Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children. LPA Emery observed poisons/toxins located in attached garage products such as Raid, Miracle Gro, Tilex mold and mildew and Clorox Cleaner. Licensee is unable to lock the garage from inside kitchen door.
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Licensee to purchase storage shed with lock and store all toxins/poisons. Licensee to submit receipts and photos to LPA by POC.
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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 SeguraTELEPHONE: (510) 286-0429
LICENSING EVALUATOR NAME: Wendy EmeryTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2016
LIC809 (FAS) - (06/04)
Page: 4 of 4