013420387-2-1-2023-02-CC-ILOA-CNMSLH-20230201125821

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420387
Report Date: 02/01/2023
Date Signed: 02/01/2023 12:58:38 PM

Document Has Been Signed on 02/01/2023 12:58 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	GONZALEZ, MARIA		FACILITY NUMBER:	013420387
ADMINISTRATOR:	GONZALEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 356-4474
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94702
CAPACITY:	14	CENSUS:	DATE:	02/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Maria Gonzalez		TIME COMPLETED:	01:07 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 February 1, 2023 at 9:04am Licensing Program Analyst (LPA) Indira Loza met with Licensee Maria Gonzalez for an Unannounced Required Annual Inspection. Present during the inspection was the Licensee, her finger print cleared husband, two fingerprint cleared assistants, four infants and four preschoolers in care. The home was toured for a health and safety inspection. The facility operates Monday through Friday between 8am-5pm. The home is a two story. The upper level home consists of a living room, dining room, two bedrooms, kitchen, and a bathroom. The lower level of the home includes two bedrooms, a bathroom, dining room, kitchen. There is a large backyard with a shed, which is off-limits to the children in care. The inside of the home was observed to be neat and clean with age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible to the child in care. ON LIMITS AREA: Are the Living room, the bedroom to the left from the living room, and the bathroom from the dining room, and the front yard OFF LIMITS AREA: Kitchen, bedroom next to the kitchen, and the entire downstairs portion of the house ISOLATION AREA: the bedroom next to the dining room LPA observed a pack-n-play for the crib-age infant in care. The Licensee provides breakfast, lunch, and snacks. The home has a fully charged 3A40BC fire extinguisher on the wall next to the kitchen, a working smoke and carbon monoxide detector. The Licensee has provided a working telephone number. The licensee's CPR and First Aid certificate is current and expires on July 2024. Per Licensee, there are no firearms in the home. LPA reviewed three staff and eight children's files. LPA obtained a copy of the facility roster. The following was observed during the inspection - The facility was overdue for the Fire Drill, the last fire/disaster drill was conducted on March 23, 2022 - There were no sleep logs for the infants *************************************Report Continues on 809-D**********************************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GONZALEZ, MARIA	FACILITY NUMBER: 013420387
	VISIT DATE: 02/01/2023

NARRATIVE

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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
Licensee is not providing IMS at this time.
Licensee was 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 licensee and discussed the Child Care Licensing Safe Sleep web page 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.
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.

See 809D for deficiencies that were cited during today's inspections.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted
Report and Appeal Right were provided to Licensee Maria Gonzalez.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/01/2023 12:58 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GONZALEZ, MARIA	FACILITY NUMBER: 013420387
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/01/2023

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, the licensee did not comply with the section cited above as the last fire drill was conducted on March 23, 2022 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/22/2023
	Plan of Correction
1 2 3 4	Licensee shall conduct a fire/disaster drill, and send the LPA a copy of the log with a current fire/disaster drill by February 22, 2023.

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in four out of fourinfants did not have a sleep log which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/22/2023
	Plan of Correction
1 2 3 4	Licensee shall send the LPA copies of sleep logs for each infant of five consecutive days by February 22, 2023.

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: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC809 (FAS) - (06/04)

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