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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417512
Report Date: 03/02/2020
Date Signed: 03/02/2020 04:20:31 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:GARCIA, MARIA TERESITAFACILITY NUMBER:
013417512
ADMINISTRATOR:GARCIA, MARIA TERESITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 487-3251
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 8DATE:
03/02/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:11 PM
MET WITH:Maria Teresita GarciaTIME COMPLETED:
04:40 PM
NARRATIVE
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On 03/02/20, Licensing Program Analyst (LPA) Plumboy arrived to the facility to conduct an Unannounced Annual Required 1 YEAR inspection. LPA was met by Licensee Maria Teresita Garcia. Present during today's visit was the Licensee fingerprint cleared spouse Tomas Garcia, assistant Pilar Sochayseng, adult son Leonardo Maragay, an exchange student from China, and 8 day care children (2 infants and 6 preschoolers). This facility currently operates from 7:00am until 6:00pm. The licensee accompanied LPA Plumboy on a tour of the home and backyard.

The home is two stories. There is a barricade/gate at the bottom of the stairs which was not in place during today's inspection. When LPA Plumboy walked into the facility through the front door of the home at 2:11pm, it was observed there was no barricade in place at the bottom of the stairs to prevent access to the second story of the home. The ON LIMIT AREAS are the entire first level of the home except the laundry room and garage. The OFF LIMIT AREAS are the laundry room, garage, and entire second level of the home which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the living room. The BACKYARD play area is completely fenced. As of 03/02/20, the backyard play area is off limits to children in care and LPA Plumboy and licensee discussed once the backyard is free from the hazardous (items such as cement bricks, wooden boards, broken toys, hoses, and the side of the yards are cleaned entirely), she must contact LPA Plumboy and receive the departments approval for the usage of the backyard prior to children in care's usage. There are toys, activities, and equipment. There are no pools, hot tubs or any other bodies of water present during today's inspection. During the inspection at 2:23pm, it was observed there was bathroom sprays on the sink counter, knives located inside the kitchen drawers, medicines and a pair of scissors on the kitchen 809-C and 809-D for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020
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: GARCIA, MARIA TERESITA
FACILITY NUMBER: 013417512
VISIT DATE: 03/02/2020
NARRATIVE
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counters and table located inside the kitchen, and Windex located on the floor inside the living room. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee's CPR/First Aide certificate is current and expires 03/30/21, licensee's husband Tomas and daughter Hannah have certificates in CPR/First Aid which expire 05/21/20. The fireplace is screened to prevent access by children. Per licensee, there are no firearms in the home.
The licensee has received a certificate in mandated reporter training on 04/10/19, her husband Tomas received a certificate in mandated reporter training on 04/09/19, and her assistant Pilar Sochayseng has yet to receive the mandated reporter training (Observed at 3:21pm while conducting file reviews, See advisory note). The licensee and her husband, have the required provider immunizations, and assistant Pilar Sochayseng must obtain proof of her provider immunization's (see 809-D for due date). Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills more then twice a year with the last one conducted on 01/30/20. A copy of the licensees roster was provided to LPA Plumboy.

Individual Medical Services (IMS) policy was discussed. 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 Plumboy provided a copy of Safe Sleep in Child Care brochure, a handout "What Does A Safe Sleep Environment Look Like?," and PIN 19-06-CCP to the licensee
LPA Plumboy provided licensee with a copy of the CDSS handout on Effects of Lead Exposure

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

809-C and 809-D for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: GARCIA, MARIA TERESITA
FACILITY NUMBER: 013417512
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2020
Section Cited

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Operation of a Family Child Care Home. Where children are less than five years old are in care, stairs shall be fenced or barricaded.
This requirement is not met as evidenced by:
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based on observation, the child safety gate was not in place at the bottom of stairs, which poses a potential health and safety risk to children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Type B
03/31/2020
Section Cited

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Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles.
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This requirement is not met as evidenced by:
Based on interview, the assistant does not have proof of measles which poses a potential risk to children in care.
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A civil penalty is being assessed today for $250 for a repeat violation. The same citation was cited on 03/12/19.
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: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2020
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: GARCIA, MARIA TERESITA
FACILITY NUMBER: 013417512
VISIT DATE: 03/02/2020
NARRATIVE
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California Law requires Family Child Care Home 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 electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day 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. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

See 809D for deficiencies cited today. The attached Type A deficiency is cited today. Upon receipt, licensee shall post for 30 days and provide copies of this licensing report to parent/guardians of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 Acknowledgement of Receipt of Licensing Reports should be signed by guardians and placed in each child’s file. This report shall remain on file for 3 years. Appeal Rights provided. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: GARCIA, MARIA TERESITA
FACILITY NUMBER: 013417512
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/03/2020
Section Cited

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Operation of a Family Child Care Home -
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.
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This requirement is not met as evidenced by:
Based on observation, there were bathroom sprays on the sink counter, knives located inside the kitchen drawers, medicines on the kitchen counter and table, a pair of scissors on the kitchen, and windex on the floor which poses an immediate health and safety risk to children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2020
LIC809 (FAS) - (06/04)
Page: 5 of 5