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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274405904
Report Date: 07/01/2022
Date Signed: 07/01/2022 12:09:59 PM

Document Has Been Signed on 07/01/2022 12:09 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:ROCHA, GRACIELAFACILITY NUMBER:
274405904
ADMINISTRATOR:ROCHA, GRACIELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 633-2106
CITY:CASTROVILLESTATE: CAZIP CODE:
95012
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
07/01/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Graciela RochaTIME COMPLETED:
12:05 PM
NARRATIVE
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Licensing Program Manager (LPM) Mary Segura and Licensing Program Analyst (LPA) Fermin Campos-Jaramillo met today with licensee Graciela Rocha in the San Jose Regional Office to discuss the findings on the investigation for uncleared individuals residing in licensee’s home. The allegation was substantiated on 6/29/2022 based on the police report obtained by this Department from the Salinas Police Department.
Licensee Rocha was asked to disclose the names of the adults residing in her home.
Licensee Graciela Rocha was also questioned on the actual address for Joshua Escobedo. Licensee Graciela has submitted previously a children’s roster listing Joshua’s residence address the address that correspond to the neighborhood park: "Rancho Moro Cojo Park" in Castroville CA.
Licensee Graciela Rocha was cited today for inimical conduct
Licensee was cited today for failure to report to this Department, the change in household composition, failing to report that the adults: Jessica Rocha, Maribel Rocha, and Joshua Escobedo had moved to live in her home. Deficiency was cited on a separate LIC809D.
Licensee was assessed with civil penalties for allowing Jessica Rocha and Maribel Rocha to continue to live in the home for the days 6/30/22 and 7/01/22 after she was informed the needed to do so, for a total of $400.00
Licensee was assessed with civil penalties for allowing Maribel Ortiz to be present in the home without a criminal record clearance for $100.00 for the day 6/29/22.
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. Appeal rights was provided to licensee Graciela Rocha, both in Spanish and in English.
LPA Campos-Jaramillo helped LPM Segura to translate into Spanish.
Licensee submitted a signed letter today stating she is surrendering her license, Licensee understands all the civil penalties assessed to her must still be paid. AB633 not reviewed as licensee is surrendering her license today.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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 3
Document Has Been Signed on 07/01/2022 12:09 PM - It Cannot Be Edited


Created By: Fermin Campos-Jaramillo On 07/01/2022 at 09:47 AM
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: ROCHA, GRACIELA
FACILITY NUMBER: 274405904

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/01/2022
Section Cited
CCR
102402(a)(3)

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102402 Revocation or Suspension of a License or Registration
(a)(3) Conduct in the operation or maintenance of a family day care home which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California.
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Licensee shall submit an statement where she declares understands this regulations and promise this violation will not repeat in the future.
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This regulation was not met as evidenced by: Licensee Graciela Rocha failed to obtain criminal records clearance or exemptions for individuals that she knew have previous convictions. This poses an immediate risk to the children in care.
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LPA discussed the requirements of AB 633 with licensee Graciela Rocha and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) LPA explained the use and purpose of the form LIC9224 and licensee Graciela Rocha stated she understands the requirements.
Type A
07/01/2022
Section Cited
CCR102370(d)(1)

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d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department.
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Licensee shall immediately deny access to the home and submit a live scan for the individual who was found inside the licensee’s home: Maribel Ortiz. This individual may not reside, work or be present until she obtains a criminal records clearance or exemption.
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This requirement was not met as evidenced by: LPA observed was in the home on 6/29/22 an adult female who stated her name is Maribel Ortiz, that individual has not received a criminal record clearance or exemptions, as it is regulated by the CCR section cited above. Licensee understands this poses an immediate risk to the health and safety of children in care.
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LPA discussed the requirements of AB 633 with licensee Graciela Rocha and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) LPA explained the use and purpose of the form LIC9224 and licensee Graciela Rocha stated she understands the requirements.
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:Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/01/2022 12:09 PM - It Cannot Be Edited


Created By: Fermin Campos-Jaramillo On 07/01/2022 at 09:53 AM
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: ROCHA, GRACIELA
FACILITY NUMBER: 274405904

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/01/2022
Section Cited
CCR
102416.2(a)(2)

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(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). (2) Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday.
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Licensee shall submit an updated LIC279 reporting all the adults residing in her home not later than on 7/08/22
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This reguation was not met as evidenced by: Licensee failed to report that adults came to reside in her home, This poses a risk to the children in care.
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Type B
07/01/2022
Section Cited
CCR102417(g)(8)

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(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841

This regulation was not met as evidenced by: Licensee failed to submit a children's roster with accurate information. This poses a potential risk to the children in care.
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Licensee shall submit a complete and accurate children's roster not later than July 8, 2022.
Type B
07/01/2022
Section Cited
HSC
1596.8595(c)

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c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b. This regulation was not met as evidenced by Licensee did not obtain a signed LIC9224 for all the parents of the children in care.
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Licensee shall obtain from all the parents of the children in care a signed form LIC9224 and submit a copy to Licensing Department by 7/08/22
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:Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2022


LIC809 (FAS) - (06/04)
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