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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408689
Report Date: 10/03/2023
Date Signed: 10/03/2023 06:37:13 PM


Document Has Been Signed on 10/03/2023 06:37 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:MULVANEY, AMYFACILITY NUMBER:
073408689
ADMINISTRATOR:MULVANEY, AMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 936-6207
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY:14CENSUS: 9DATE:
10/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:AMY MULVANEYTIME COMPLETED:
02:30 PM
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8:00am Licensing Program Analyst Tasha Alexander met with licensee Amy Mulvaney for an unannounced 1 YEAR/REQUIRED inspection. Present for the inspection were licensee, her husband, assistant Crystal Miller and 9 preschool age children in care. LPA toured the facility and backyard for a health and safety inspection. The children's files were also reviewed. Today the home is observed to be clean and has sufficient heating and ventilation for the safety and comfort of children in care. The home is a single story home. There is a fully charged 2A10BC fire extinguisher, a working smoke detector, and a working carbon monoxide detector. All were inspected/tested and found to be in working condition. There is a working telephone in the home, no change in phone number. The fireplace in the living room is screened. Per licensee there are no fire arms/weapons on the premises. Outdoor play is in the backyard which is fully fenced. LPA observed an ample supply of age appropriate toys and activities, which were in good condition and free of defects. There are no swimming pools, hot tubs, or other bodies of water observed at the home. All poisons, cleaning solutions and medications are inaccessible to children. Licensee has current CPR and 1st Aid training which expires 10/26/2024 respectively. The licensee conducted a fire/disaster drill on 8/23. The primary areas for child care are: The play room which is adjacent to the office/storage room, the bathroom located near the laundry area, the kitchen and the living room. The off limits (children are not allowed) areas are: the 3 bedrooms, hall bathroom, living room, office/storage room and detached garage. The isolation area is a section of the living room, away from other children in care. Day care is primarily conducted outdoors on a half day schedule. Licensee was reminded that baby walkers, excersaucers, baby bouncers and drop-down cribs are not allowed. LPA did not observe any of the aforementioned items today. Children's files were found to be complete. Licensee was also informed of the licensing web address ( www.ccld.ca.gov) for downloading child care forms and (www.myccl.com) to register to receive child care updates.

CONTINUED ON 809-C
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2023
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: MULVANEY, AMY
FACILITY NUMBER: 073408689
VISIT DATE: 10/03/2023
NARRATIVE
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A review of staff records on 9/28/23 indicates that all facility staff or other individual who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Effective September 1, 2016, a person may not work or volunteer at a child care center or family child care home unless he or she has been vaccinated against pertussis, measles and influenza or has an exemption. Licensee has immunization records in file. licensee declines the flu vaccine. Licensee's assistant Crystal does not have immunization records in file today.

Today the newly implemented mandatory mandated reporter training course has also been discussed. Licensee's certificate is up to date. Licensee's assistant does not have the certificate in file today.

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. 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.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
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: MULVANEY, AMY
FACILITY NUMBER: 073408689
VISIT DATE: 10/03/2023
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LPA briefly discussed the safe sleep regulations with licensee and provided 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 [or facility representative] 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. The licensee stated that she does not plan to provide care for infants.

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/.

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

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA Alexander completed the RSO profile in FAS on 8/29/23.

A notice of site visit was given and must remain posted for 30 days.

See 809D for deficiencies being cited today.

An exit interview was conducted and this report was reviewed with the licensee, (first/last name). Appeal rights were provided.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/03/2023 06:37 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: MULVANEY, AMY
FACILITY NUMBER: 073408689

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. a review of records revealed assistant Crystal miller does not have the mandated reporter certificate in file
POC Due Date: 10/17/2023
Plan of Correction
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licensee will have her assistant complete the mandated reporter training and submit a copy of the updated certificate to community care licensing by 10/17/23
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. a review of records revealed assistant Crystal does not have immunization records in file
POC Due Date: 10/17/2023
Plan of Correction
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Licensee will have her assistant obtain a copy of her immunization records and submit a copy to community care licensing by 10/17/23
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: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2023
LIC809 (FAS) - (06/04)
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