073405891-10-20-2020-02-CC-CFES-BUL53B-20201020193541

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405891
Report Date: 10/20/2020
Date Signed: 10/20/2020 07:37:10 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	MORENO, MARIA A.		FACILITY NUMBER:	073405891
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	10/20/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	06:07 PM
MET WITH:	Maria Moreno		TIME COMPLETED:	07:45 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 October 20, 2020 at 6:07PM, Licensing Program Analyst (LPA) Catherine Fernandes conducted an announced Case Management Inspection with Licensee Maria Moreno regarding an increase in capacity via FaceTime. Residing in the home is the Licensee, her finger print cleared husband and two underage children. Present during the inspection was one toddler, two school age children, Licensee's husband, Licensee's adult son and brother in-law. The day care children were later picked up during the inspection. The home was virtually toured with the Licensee to conduct a health and safety inspection. Due to COVID-19 LPA focused mainly on the physical plant of the home and an annual was conducted on January 9, 2020. Operating hours will be 6:00am to 6:00pm, Monday through Friday. The home is a single story house that consists of three bedrooms and two bathrooms. The OFF LIMIT AREAS are the master bedroom and bathroom, the garage and the entire backyard which will be inaccessible by gate, closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the living room which is the main area of the day care, the kitchen, dining room, family room, the first two bedrooms on the right side of the hallway and the hallway bathroom. The ISOLATION AREA will be in the first bedroom on the right. LPA did not observe any hazardous materials or toxins accessible to children today. The home has a fully charged 2A10BC fire extinguisher on the kitchen counter and pull down fire alarm on the wall next to the front door. A working smoke detector in the kitchen, a carbon monoxide detector in the hallway near the bedrooms, a working telephone, and First Aid Kit. Per Licensee, there are no firearms in the home. The Licensee was reminded of the responsibility as a mandated reporter and has provided proof of the required mandated reporter training for child care providers, which has been completed on 10/4/20. On 10/14/20, a fire clearance was granted to facility #073405891 by Contra Costa County Fire Protection District. All documents have been reviewed for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home. Report Continues on 809C.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: MORENO, MARIA A.	FACILITY NUMBER: 073405891
	VISIT DATE: 10/20/2020

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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. All forms can be downloaded at www.ccld.ca.gov .

The following items need to be submitted to CCLD before an increase is to be considered:
- EMSA First Aid Certificate
- Fingerprint clearance for Licensee's son

There are no deficiencies cited today.
The report will remain on file for three years.
An exit interview was conducted with Licensee. Report mailed and emailed.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020

LIC809 (FAS) - (06/04)

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