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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415205
Report Date: 02/08/2023
Date Signed: 02/08/2023 03:15:39 PM


Document Has Been Signed on 02/08/2023 03:15 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:SORIA ALCAZAR, MARIAFACILITY NUMBER:
013415205
ADMINISTRATOR:SORIA ALCAZAR, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 606-0397
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:14CENSUS: 5DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Maria Soria AlcanzarTIME COMPLETED:
03:30 PM
NARRATIVE
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On February 8, 2023 at approximately 11:30am Licensing Program Analyst (LPA) Russ Haderer met with licensee Maria Soria Alcazar for the purpose of conducting an unannounced 1-year annual inspection for Health and Safety compliance. Present for today’s inspection was the licensee, her fingerprint cleared assistant Lucia Sandoval, four infant children and one preschool age child. The hours of operation are Monday-Friday, 7:00 AM to 6:00 PM.

The facility is a 5-bedroom, three bath two-story home an attached 2-car garage enclosed (fenced) backyard play area. There is a fireplace in the family room with a screen. The home is neat and clean with heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the living room away from the other children in care.



On-limit include: Downstairs child care room; child care eating area (west side of kitchen); family room (with screened fireplace); living room; hallway; bedroom for napping on middle left side of hall; house bathroom at the end of the hall and the backyard. Licensee was reminded that other than wipes or things used for the children in the children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits area.
Off-limits include: Kitchen, back bedrooms on the right side of the hall, back bedroom attached to the living room and, upstairs (stairs behind a shut and locked door) and attached 2-car garage. Off limit areas are inaccessible by closed and/or locked doors, child gates and visual supervision.

Disaster drills are conducted every month, the last one was done 2-03-2023. Per licensee, there are no firearms in the home. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection. The backyard play area has age appropriate toys and small structures. Licensee has two first aid kits in the kitchen.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
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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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: SORIA ALCAZAR, MARIA
FACILITY NUMBER: 013415205
VISIT DATE: 02/08/2023
NARRATIVE
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Licensee has ample age-appropriate toys and learning materials in the home. There is a fully charged 3A40BC fire extinguisher in the child care room; a working smoke and carbon monoxide detector (tested and functioning), and a working telephone.

The Licensee and Assistant’s CPR and First Aid certificates are current and expire (licensee 1-06-2025; Assistant 8-06-2024). The licensee’s and assistant's mandated reporter training (verified AB1207) is current, both completed on 8/12/2022. Licensee is in compliance with immunization laws which pertains to day care providers, assistant has proof of TB test, but no record for measles and pertussis immunization - see LIC809D for deficiency.



LPA reminded the licensee of the following: Mandated Reporter training is to be renewed every two years; CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

LPA reviewed children’s and facility files. One child’s file had incomplete immunization records, 1 infant children’s records were missing the LIC9227 Infant Safe Sleep plan – see LIC809D for deficiencies. Sleep logs were available and checked. Licensee does not carry liability insurance, all children’s files contained signed acknowledgement forms from parents.

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

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
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: SORIA ALCAZAR, MARIA
FACILITY NUMBER: 013415205
VISIT DATE: 02/08/2023
NARRATIVE
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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/inspection-process.

There were three deficiencies issued during today’s inspection: Immunization for helper’s MMR and tdap; missing LIC9227 Infant Safe Sleep plan; complete immunization records for one child. See LIC809D for deficiencies.

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

Exit interview conducted and report was reviewed with the licensee Maria Soria Alcazar.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 02/08/2023 03:15 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: SORIA ALCAZAR, MARIA
FACILITY NUMBER: 013415205

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in licensee's assistant did not have proof of immunization for measles and pertussis which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/08/2023
Plan of Correction
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Licensee to collect immunization records for pertussis and measles (or proof of immunity to measles) and maintain the records in the personal file. Going forward, all assistants must provide records of vaccination for measles, pertussis, TB and a flu shot (or declination for flu shot).
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that one child's immunization records were incomplete and not updated which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/22/2023
Plan of Correction
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Licensee to collect current immunization records for child missing updates and going forward will ensure all children's forms are complete in each child's file.
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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6


Document Has Been Signed on 02/08/2023 03:15 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: SORIA ALCAZAR, MARIA
FACILITY NUMBER: 013415205

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)(2)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that one infant children's files did not have the LIC9227 Safe Sleep Plan completed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/10/2023
Plan of Correction
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Licensee will have parents complete the form and going forward, all infants age 0 to 12 months must have this form completed, signed and dated.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
LIC809 (FAS) - (06/04)
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