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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005532
Report Date: 11/30/2021
Date Signed: 11/30/2021 06:23:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MUNOZ, MARCIA F.FACILITY NUMBER:
214005532
ADMINISTRATOR:MUNOZ, MARCIA F.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 879-2587
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:14CENSUS: 10DATE:
11/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Marcia MunozTIME COMPLETED:
02:30 PM
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On 11/30/21 at 12:00 pm., Licensing Program Analyst (LPA), Farhan Bashir-Tariq arrived the facility above unannounced to conduct a required one-year inspection and met with Licensee, Marcia Munoz. Purpose of the inspection was explained. There were 10 children present today with Licensee and a helper, Iris Munoz. Licensee rents the home, which is a two bedroom and one-bathroom single family home. All adult residents have the fingerprint clearance on file. Licensee was following staff and child ratio on this day. Days and Hours of operation are: M-F, 7AM- 7PM. Licensee provides breakfast, lunch and two snacks Daycare areas: Living room/Playroom, Living room #2 (napping inly), Bedroom #2 (napping only), Back Yard and Bathroom. OFF limit areas: Bedroom #1, Kitchen, Closets, Garage and Front Yard.

LPA and Licensee inspected the entire home for health and safety hazards as previously only a virtual inspection was conducted due to COVID-19 restrictions in place. All off limit areas were properly barricaded and made inaccessible to the children in care. Home is clean and orderly with enough lighting and ventilation. Kitchen is off limit and has been blocked off with doors on both sides. LPA observed that there were working smoke detectors and carbon monoxide detectors available in the home. Fire extinguisher of size 2A10BC or bigger was also available in the home. There was a working telephone available in the home. First Aid Kit and emergency supplies were fully stocked and accessible. All harmful chemicals and sharp objects were made inaccessible from children in care. Licensee states, there are no firearms, guns or weapons in the home. Per Licensee, there is a dog in the home. Licensee states that there are no pools or other bodies of water in the home. Licensee has a CPR and First Aid card, which will expire in January 2023. Licensee took mandatory child abuse training on 8/18/2020, which is valid for two years.
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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MUNOZ, MARCIA F.
FACILITY NUMBER: 214005532
VISIT DATE: 11/30/2021
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Licensee understands the requirement of conducting and logging an emergency and fire drill once every six months. Per Licensee’s log, last drill was conducted on 11/2/2021. Home has age appropriate toys, books and equipment available for the children in care. All posting requirements were met and posted near the main entrance. Licensee was reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. During the visit, LPA reviewed that masks, sanitizers and cleaning wipes were available in the home. Licensee was reminded to clean and disinfect day care areas thoroughly at least once a day. Hand washing and COVID posters were observed to be available at entrance and inside the home.

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

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.

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.

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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MUNOZ, MARCIA F.
FACILITY NUMBER: 214005532
VISIT DATE: 11/30/2021
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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.

LPA reminded Licensee, as of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training (AB1207) every two years. The training can be obtained online at www.mandatedreporterca.com. LPA encouraged facility Director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.


>No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

An exit interview was conducted. This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was given and must remain posted for 30 days from today's visit. Facility was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. For Rules and Regulations, visit the Website: www.cdss.ca.gov

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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
LIC809 (FAS) - (06/04)
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