073406723-2-5-2020-02-CC-PPEN-BLHT8J-20200205133024

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073406723
Report Date: 02/05/2020
Date Signed: 02/05/2020 01:30:34 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:	MONJARAZ, JERRALINE		FACILITY NUMBER:	073406723
ADMINISTRATOR:	MONJARAZ, JERRALINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 669-5367
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94803
CAPACITY:	14	CENSUS: 3	DATE:	02/05/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Jerraline Monjaraz		TIME COMPLETED:	01:40 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	Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced random annual site inspection for this facility at 1205. LPA met with licensee, Jerraline Monjaraz, who was present along with licensee's 17 year old granddaughter, and three preschool age children in care. One additional infant age child arrived while LPA was still present. The facility is within ratio and capacity. All required adults are background cleared and associated to this facility. Children are supervised at all times. LPA toured all areas of the facility on-limits to children in care for a health and safety inspection. On limits area are; the upstairs living room, dining room and kitchen and hall bathroom. Off limits areas are made inaccessible by closed doors or child safety gating and visual supervision. There is a closed door at the top of the stairs. There is a fireplace which is screened to prevent access by children. Per licensee there are no firearms present or stored on the premises. The facility has a working carbon monoxide detector, working fire alarm and a fully charged 4A60BC fire extinguisher. The outdoor yard and patio area is fully fenced and on limits to children in care. There are no pieces of high climbing equipment or swings present. There are no pools, hot tubs or other bodies of water accessible to children in care. The separate storage shed is locked/fastened to prevent access by children. LPA reviewed the facility and children's records including parents' rights forms, emergency ID forms and consent for emergency medical treatment. Licensee and licensee's daughter have current CPR/First Aid certification which expires 05/2021. At approximately 1230, LPA observed that the Parent's Rights Poster was not currently posted. The facility roster is current. Continued on Page 2**************************************************************************************

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

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: MONJARAZ, JERRALINE	FACILITY NUMBER: 073406723
	VISIT DATE: 02/05/2020

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LPA reviewed with licensee the current Facility Personnel Report Summary and verified that all adults requiring background clearances are cleared and associated to this facility.

The Safe Sleep Awareness Campaign "New and Proposed Safe Sleep Regulations and Best Practices" was provided and reviewed. Licensee is encouraged to visit www.ccld.ca.gov for licensing regulations and forms. To sign up for quarterly updates contact: childcareadvocatesprogram@dss.ca.gov. Licensee is reminded that Mandatory Reporter Training is to be renewed every two years.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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

The attached Type B deficiency was cited and cleared during this inspection. A notice of site visit was provided and is to remain posted for 30 days from today's date. A copy of this report is to be available in the facility records for a period of three years from today's date.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: MONJARAZ, JERRALINE	FACILITY NUMBER: 073406723
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/05/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/20/2020 Section Cited	1 2 3 4 5 6 7	102419(b)The licensee shall post the PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster in a prominent, publicly accessible area in the family child care home at all times children are in care. This facility was not in compliance with this requirement as evidenced by LPA's observation that there was not a Parent's
	8 9 10 11 12 13 14	Rights Poster present and posted at this facility at the time of this inspection posing a potential risk to the health and safety of children.	8 9 10 11 12 13 14	per violation and $100 per day until corrected.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

LIC809 (FAS) - (06/04)

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