013419824-5-8-2024-52-CC-EWOS-D53NPC-20240508103808

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419824
Report Date: 05/08/2024
Date Signed: 05/08/2024 10:41:50 AM

Document Has Been Signed on 05/08/2024 10:41 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	CHAVEZ, MARJORIE		FACILITY NUMBER:	013419824
ADMINISTRATOR/ DIRECTOR:	CHAVEZ, MARJORIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 393-5063
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 3	DATE:	05/08/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Marjorie Chavez		TIME VISIT/ INSPECTION COMPLETED:	10:55 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 May 8, 2024, at 8:30 AM, Licensing Program Analyst (LPA) Elimika Woods met with licensee Marjorie Chavez for an Unannounced Annual/Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection were three children, one (1) school age child, and two (2) preschool age children. Also present during the inspection was the licensee's fingerprint cleared son. The licensee stated that the facility operates from Monday to Friday 5:30 AM to 6:30 PM. LPA toured the facility inside and out to conduct a Health and Safety inspection. This single-story home consists of three bedrooms, two baths, a living and dining room, kitchen, backyard and two one car attached garages. This home was clean and orderly, with (centralized) heating and ventilation for the safety and comfort. The Isolation area of the home will be a section of the hallway, away from other children in care. The off-limits will be made inaccessible by closed and/or locked doors and visual supervision. LPA checked the cabinets in the kitchen, bathroom, and any other cabinets or drawers accessible to children in care. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. At 8:45 AM, LPA inspected the backyard area to make sure that there are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. On-limit-areas are the: Bedroom (1) in the front middle area of home, living room, dining room, kitchen, hallway bathroom, and backyard. Off-limit-areas are the: Left side of the backyard which is inaccessible by a gate/barrier, bedroom (2) bedroom (3), and first and second garage. LPA tested the smoke detector and the carbon monoxide detector in the living room and found them to be functioning properly. The licensee showed me her first aid kit that she keeps in the kitchen cabinet, and a fully charged 2A10BC fire extinguisher located in the kitchen cabinet, which meets standards established by the State Fire Marshal. See 809-C for continuance.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHAVEZ, MARJORIE	FACILITY NUMBER: 013419824
	VISIT DATE: 05/08/2024

NARRATIVE

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The home has centralized heating to keep the children comfortable during cold days. LPA asked the licensee does she transports children and the licensee stated that she does not transport children. During the record review, LPA Woods checked the health records of the licensee and children and found that the licensee is following the immunization laws which pertain to all childcare providers. All required forms are posted and visible for public review.

The OUTDOOR PLAY area is the fully fenced backyard. During today's inspection, there are no play structures which are required to be anchored. There are ample age-appropriate toys that appear to be safe and in good condition. The left side of the backyard is off-limits to children in care, which is inaccessible by a gate/barrier.

The following deficiencies were observed during today's inspection:
At 8:45 AM, LPA observed the backyard fence in need of repair and leaning forward.

At 9:00 AM LPA requested and reviewed the files of two (2) children in care. All children’s files contain Immunization, Identification & Emergency Information, Parent's Rights, and Medical Consent forms. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 02/20/24. The licensee's Health and Safety training is completed, and CPR and First Aid certificate is current and expires on 08/2025. The licensee has completed mandated reporter training on 03/08/24. The licensee is in ratio today.

LPA Woods also observed children at 9:00 AM, working on writing handouts provided by the license as part of their daily schedule on tables she has in the kitchen area. The children worked on their penmanship for about thirty minutes before being dismissed for free-play where they were playing with building blocks in the living room area together.

Effective August 1, 2003, 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 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. The licensee was also reminded 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.

See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHAVEZ, MARJORIE	FACILITY NUMBER: 013419824
	VISIT DATE: 05/08/2024

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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-andresources/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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

The licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Marjorie Chavez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See 809-D for deficiency cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Marjorie Chavez.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/08/2024 10:41 AM - It Cannot Be Edited

Created By: Elimika Woods On 05/08/2024 at 10:27 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: CHAVEZ, MARJORIE	FACILITY NUMBER: 013419824
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)

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: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in which the backyard fence was leaning and in need of repair which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/10/2024
	Plan of Correction
1 2 3 4	License will have the gate repaired and will send LPA photos of the finished fence by 06/10/2024 by regular mail, fax, or email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Charles

LICENSING EVALUATOR NAME:

Elimika Woods

LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC809 (FAS) - (06/04)

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