073408307-10-30-2023-02-CC-ILOA-CX4TWL-20231030150544

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408307
Report Date: 10/30/2023
Date Signed: 10/30/2023 03:05:50 PM

Document Has Been Signed on 10/30/2023 03:05 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:	WALLE-ULLOA, MARTA		FACILITY NUMBER:	073408307
ADMINISTRATOR:	WALLE-ULLOA, MARTA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 610-1592
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94806
CAPACITY:	14	CENSUS: 3	DATE:	10/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Marta Walle-Ulloa		TIME COMPLETED:	03:16 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 30, 2023 at 1:20pm Licensing Program Analyst (LPA) Indira Loza met with Licensee Marta Walle-Ulloa for the purpose of conducting an unannounced 1-year annual inspection. Present during today's inspection were the Licensee, two preschool-age children, and one infant. Operating days and times are Monday - Friday 6am-6pm The home is a two story house consisting 5 bedrooms, 3 bathrooms, living room, family room, kitchen, den, laundry room, garage and backyard. The home is neat and clean with central heating and ventilation for safety and comfort. On Limit Areas - downstairs bedroom, family room, bathroom, dining area, upstairs bedroom (infant nap room), kitchen, and backyard Off Limit Areas - 4 upstairs bedrooms, living room, garage, and laundry room Isolation Area - In the Den The home has a fully charged 3A40BC fire extinguisher, a working carbon monoxide detector, and a working telephone. Licensee does not have Liability Insurance and files reviewed had the "Affidavit Regarding Liability Insurance for Family Childcare Home" (LIC 282). Per the Licensee there are no firearms in the home. The Licensee has a current CPR/First Aid certificate which expires on July 2024 and a current Mandated Reporter Certificate which expires on July 18, 2024. The home has heating and ventilation for safety and comfort. LPA observed the fully fenced backyard to be clean with age-appropriate toys and learning materials. LPA observed the inside of the home to have plenty of age appropriate toys and activities for the children in care. Toxins, medicines, and hazardous items were inaccessible during today's inspection. The Licensee provides food to the children. There were no bodies of water on the premises of the daycare. LPA observed a fireplace which was blocked to prevent access children from the children. ********************************Report Continues on LIC 809-C*****************************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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: WALLE-ULLOA, MARTA	FACILITY NUMBER: 073408307
	VISIT DATE: 10/30/2023

NARRATIVE

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getting near it. LPA observed gates on the top and bottom of the staircase. The fire drill log was current and the last fire drill conducted was on October 7, 2023. The Licensee stated she does not provide overnight care to the children.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02. When any IMS is 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 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 in 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.

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-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/inspection-process.

During the Exit Interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility ***********************************Report Continues on LIC809-C***********************************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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: WALLE-ULLOA, MARTA	FACILITY NUMBER: 073408307
	VISIT DATE: 10/30/2023

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 26 27 28 29 30 31 32	and LPA completed the RSO profile in FAS. There were no deficiencies cited during today's visit. Exit interview conducted and report was reviewed with Licensee Marta Walle-Ulloa. Report and Appeal Rights were provided. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC809 (FAS) - (06/04)

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