013412291-6-20-2023-52-CC-MPRE-CSYU2H-20230620151159

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013412291
Report Date: 06/20/2023
Date Signed: 06/20/2023 03:12:08 PM

Document Has Been Signed on 06/20/2023 03:12 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, 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: 9	DATE:	06/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:56 PM
MET WITH:	Myriam Zuniga & Miguel Henriquez		TIME COMPLETED:	03:10 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 6/20/2023 at 12:56pm Licensing Program Analyst’s (LPA’s) Morgan Pringle and Jaleesa Jackson met with Licensees' Myriam Zuniga and Miguel Henriquez for a Required – 1 Year Inspection. Present during the inspection were the Licensee’s, their adult daughter M. Henriquez, four (4) school age children and five (5) preschool age children. Licensees' live in the home with their daughter. The facility operates from 7:00am – 6:00pm, Monday - Friday. ON LIMITS AREA: Living Room, Family Room (Children’s Area), Kitchen, Converted Garage, Hallway Bathroom and Backyard OFF LIMITS AREA: Two (2) Bedrooms, Master Bedroom and Bathroom ISOLATION AREA: Living Room The facility is a single-story home rented by the Licensees. The inside of the home is observed to be clean with ample age-appropriate materials for the children. All toxins, cleaning products, personal medications, and hazardous materials were observed to be in inaccessible areas. Licensees have stated that there are no firearms one (1) cat in the home. The home has one (1) fully charged 3A40BC fire extinguisher in the garage above the diaper changing area and one (1) working smoke/carbon monoxide detector in the garage. The fireplace in the living room is screened and not in use making it inaccessible to the children in care. The home is equipped with plenty of windows for proper ventilation and central heat. All napping equipment is clean, free from defects and properly maintained. Licensees provides all food for the children and provides transportation. LPA did not observe any harmful bodies of water in or around the home.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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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Document Has Been Signed on 06/20/2023 03:12 PM - It Cannot Be Edited

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: 06/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/23/2023
	Plan of Correction
1 2 3 4	Licensees' will conduct a fire/disaster drill by POC date and record it. A copy of the record will be sent to LPA Pringle by 6/23/2023. Licensee's will continue to conduct drills every six months

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/23/2023
	Plan of Correction
1 2 3 4	Licensee Miguel Henriquez will complete the 8 hour Pediatric CPR & First Aid training by the POC date. If training cannot be completed a training must be registered for by POC date. Licensee will send LPA Pringle record of the completed training or a record of the registration.

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 Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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: 06/20/2023

NARRATIVE

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Licensees’ Health and Safety training has been completed. Myriam Zuniga’s Pediatric CPR and First Aid training is complete and expires 10/27/2024. Miguel Henriquez’s pediatric CPR & First Aid training expired in 6/2022. Licensees’ Mandated Reporter trainings are complete and expires 5/26/2024 and 5/27/2024. All required forms are posted and visible for public view in the garage above the cubbies. Licensee’s fire drill log is incomplete with the last drill logged 10/20/2022. LPA obtained a sample of the children’s files, facility files, and facility roster. All files were complete.

Deficiencies cited during inspection
· Licensee, Miguel Henriquez, CPR training has expired
· Fire/Disaster drills have not been completed in over 6 months

Licensees were 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 624B). Incidents must be reported within 24 hours by phone, fax, or email. Licensees were reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. Licensees were reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensees were also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com. LPA informed Licensees that all forms can be downloaded at www.ccld.ca.gov.

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.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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: 06/20/2023

NARRATIVE

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Licensees were reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensees and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensees of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Licensees’ Myriam Zuniga and Miguel Henriquez.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC809 (FAS) - (06/04)

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