<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412291
Report Date: 08/03/2021
Date Signed: 08/03/2021 12:15:24 PM

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, MIGUELFACILITY NUMBER:
013412291
ADMINISTRATOR:ZUNIGA, MYRIAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 244-7258
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY:14CENSUS: 8DATE:
08/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Miguel Henriquez & Myriam ZunigaTIME COMPLETED:
12:15 PM
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 8/3/2021 at 10:25am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee’s Miguel Henriquez and Myriam Zuniga for an unannounced annual inspection. Present during the inspection were the Licensee’s and their fingerprint cleared daughter Marisol Henriquez. There was four (4) school age children and four (4) preschool children present during the inspection. Licensee’s live in the home with their adult daughter M. Henriquez. The Licensee’s home was toured for a health and safety inspection. The operating hours are 7:00am – 6:00pm Monday – Friday.

ON LIMITS AREA: Converted Garage, Kitchen, Living Room, Children’s area, Hallway Bathroom and Backyard


OFF LIMITS AREA: All 3 Bedrooms, Master Bathroom,
ISOLATION AREA: Living Room

The facility is a single-story home owned by the Licensee. The inside of the home is observed to be neat, clean with ample age appropriate materials for the children that are safe and clean. Most toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Cleaning products under the kitchen sink are accessible to children from a broken lock on the door. Licensee has stated that there no firearms and two (2) cats.

The home has one (1) fully charged 3A40BC fire extinguisher in the garage. There is one (1) working smoke detector in the children’s area and the garage. There is a working carbon monoxide detector in the hallway by the living room. The home is equipped with central heat in the home and a portable heater in the garage that is covered by a fence and made inaccessible to the children in care. The home is equipped with ceiling fans and multiple windows for proper ventilation. Fire place in Children's room is screened off and made inaccessible to children in care. Cont on 809-C
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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
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: 08/03/2021
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
26
27
28
29
30
31
32
At 11:15am LPA obtained the facility roster and the children’s files. All files are complete. The Licensee’s Health and Safety training has been completed and CPR and First Aid training is complete with an expiration date of June/July 2022. Licensee’s fire and disaster drill log is not complete with the last drill logged 3/23/2020. All required forms are posted and visible for public view in the garage.

Licensee was reminded that California Law requires licensees to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.



Licensee is reminded that ALL Licensees, 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 $3,000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter.

All fire/disaster drill must be conducted every six months and documented. The Licensee is reminded that any structural changes to the facility or additions to the childcare facility must be reported to Community Care Licensing.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

This report was read and given to the Licensee for a signature. There is two (2) deficiencies being cited today. This report shall remain on file for 3 years. Appeal Rights were provided and exit interview conducted. A Notice of Site visit was given and must be posted for 30 days.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/03/2021
Section Cited

1
2
3
4
5
6
7
102417(g)(4)Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: Toxins and cleaning materials under the kitchen sink are in a cabinet with a broken lock. This poses a potential health and safety risk to the children in care.
8
9
10
11
12
13
14
Type B
08/03/2021
Section Cited

1
2
3
4
5
6
7
102417(g)(9)(A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home. This requirement was not met as evidenced by:
8
9
10
11
12
13
14
Licensee's have not completed a disaster drill since March 2020.
8
9
10
11
12
13
14
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: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3