013412291-6-4-2019-52-CC-LDYN-BCTPYD-20190604114345

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013412291
Report Date: 06/04/2019
Date Signed: 06/04/2019 11:43:50 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	ZUNIGA, MYRIAM & HENRIQUEZ, MIGUEL		FACILITY NUMBER:	013412291
ADMINISTRATOR:	ZUNIGA, MYRIAM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 244-7258
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94545
CAPACITY:	14	CENSUS: 4	DATE:	06/04/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	10:23 AM
MET WITH:	Myriam Zuniga & Miguel Henriquez		TIME COMPLETED:	11:53 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 6/4/19 at 10:23am, Licensing Program Analyst (LPA) Loretta Dyson arrived at the home for an unannounced required inspection. LPA met with both licensees. There were 2 infants, 2 preschool age children and the licensee's fingerprint cleared daughter also present. The home is a single story home, which consists of the living room, dining room, family room, kitchen, 3 bedrooms, 2 bathrooms, and garage that has been converted into the child care room. The home is neat and clean with heating and ventilation for the safety and comfort of children in care. At 10:38am, LPA began a tour of the areas of the home that are used for the child care. The on limit areas include the converted garage, the bathroom at the end of the hallway, the first bedroom on the right side in the hallway used for napping, the kitchen, dining room, family room, and living room for children to walk thru to the bathroom. The off limit areas include the two bedrooms at the end of the hallway, and the bathroom inside of the bedroom. These areas are made inaccessible by closed and/or locked doors and visual supervision. The isolation area is a section of the family room, away from other children in care. LPA observed a considerable amount of toys and activities available for children, and they are age appropriate and in good repair. LPA did not observe any bodies of water, hazardous items or toxins accessible to children today. There is a functional combination smoke/carbon monoxide detector, telephone, first aid supplies, and a fully charged 3A40BC fire extinguisher. The fireplace is blocked by gate to prevent access by children, and there are no heaters accessible to children. Per the licensees, there are no firearms in the home. Both of the licensees, and their daughter, have current CPR/first aid certificates which expire on 3/15/20. The licensees conduct and document fire and earthquake drills at least twice a year, and the last drills were completed on 5/22/19. LPA reviewed and obtained a copy of the facility roster. LPA made observations during the inspection, and did not observe any violations of, or concerns with, the personal rights of children.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ZUNIGA, MYRIAM & HENRIQUEZ, MIGUEL	FACILITY NUMBER: 013412291
	VISIT DATE: 06/04/2019

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The licensee stated that there are no children enrolled at this time, who require medication while in care.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. LPA reviewed the individuals associated to the license, and the licensee confirmed that everyone who is required to have a criminal record clearance is associated. Licensee was reminded of the responsibility as a mandated reporter. The licensee was advised of the required mandated reporter training to be completed as of 1/1/18, at mandatedreporterca.com.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov. The Licensee was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet and LPA discussed safe sleep practices and policy.

There are no deficiencies being cited today. This report shall remain on file for 3 years. A Notice of Site visit was given to Licensee, and Licensee was reminded that it is required to be posted for 30 days. An exit interview was conducted.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019

LIC809 (FAS) - (06/04)

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