<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270767399
Report Date: 02/28/2023
Date Signed: 03/02/2023 04:36:51 PM


Document Has Been Signed on 03/02/2023 04:36 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:MERILOS, SMYRNAFACILITY NUMBER:
270767399
ADMINISTRATOR:MERILOS, SMYRNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 449-7958
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY:14CENSUS: 3DATE:
02/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Smyrna Merilos & Remedios Bucsit TIME COMPLETED:
04:45 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
Licensing Program Analyst (LPA) Elizabeth Larios met with Smyrna Merilos, Licensee, for an unannounced Required – 1 year annual inspection. LPA was granted access to the home by the Assistant Remedios. LPA observed five day care children, and Licensee's infant grandchild and school age granddaughter in the home during today's inspection. Licensee was operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 7:00 AM to 5:30 PM. Licensee & spouse, and adult daughter are the only adults residing in the home.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on January 10, 2023. Licensee does not have liability insurance for the day care. Licensee has a current CPR and First Aid certifications (expiration: November 1, 2024). Licensee did not have the required vaccines (MMR, Tdap, & flu) documentation and does not have current Mandated Reporter Training for Child Care Workers Certificate. LPA reviewed six children's files and the files were incomplete with the required forms. LPA reviewed one staff file including (Licensee) and the file was incomplete with the required forms.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home. The home is clean, orderly, (including heating/fans/ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. The off limit areas inside the home is the garage, and all four bedrooms. Backyard was observed fenced, and no bodies of water were observed.

LPA observed a fully charged 3A40BC fire extinguisher in the kitchen, working smoke/carbon monoxide detectors. The Licensee stated that there are weapons/ firearms in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children and stored in the kitchen, and garage. Licensee states that she does not administer any medications to the day care children at this time.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MERILOS, SMYRNA
FACILITY NUMBER: 270767399
VISIT DATE: 02/28/2023
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
Licensee states that she provides breakfast, snacks, lunch, and dinner to the day care children. Licensee states that she understands that any food brought from home needs to be labeled with each child's name and properly stored. Licensee has a first aid kit in the home. Licensee states that nobody smokes and she understands that smoking is prohibited in 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

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee states that a child will be isolated in the kitchen area if necessary due to illness or communicable disease. Licensee states she does transport day care children. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

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.

LPA discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MERILOS, SMYRNA
FACILITY NUMBER: 270767399
VISIT DATE: 02/28/2023
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
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 atwww.cdss.ca.gov/inforesources/community-care-licensing/process

Exit interview conducted and report was reviewed with the Licensee, Smyrna Merilos. Deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 03/02/2023 04:36 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: MERILOS, SMYRNA
FACILITY NUMBER: 270767399

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above LPA observed missing wood flooring in hallway and partially in the living room area. LPA observed floor to be sticky and saw blue tape place in the edges of floor to prevent injury and and tripping. LPA saw areas that were not covered with blue tape that can cause injury which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
1
2
3
4
Licensee will repair flooring and submit pictures to San Jose Regional Office (SJRO) by POC date.
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above licensee does not have every 15 minute documention for infant who is six months which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
1
2
3
4
Licensee will submit a safe sleep log for infant to San Jose Regional Office (SJRO) by POC date.
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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
LIC809 (FAS) - (06/04)
Page: 7 of 7


Document Has Been Signed on 03/02/2023 04:36 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: MERILOS, SMYRNA
FACILITY NUMBER: 270767399

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2023

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
1
2
3
4
Based on record review, licensee did not comply with the section cited above licensee, helper (spouse), and assistant did not complete their Mandated Reporter Training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
1
2
3
4
Licensee, helper (spouse), and Assistant agreed to complete Mandated Reporter Training before or by POC date and submit proof of completion to the San Jose Regional Office (SJRO) by POC date.
Type B
Section Cited
CCR
102416.1(d)
Personnel Records
(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above Licensee did not have her own, helper (spouse), Assistant record requirements readily available o for LPA to review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
1
2
3
4
Licensee will submit to San Jose Regional Office (SJRO) by POC date her own complete records as well as helper (spouse) as required but not limited to: Proof of Immunization (measles, pertussis, flu), and Tuberculosis clearance.
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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
LIC809 (FAS) - (06/04)
Page: 4 of 7


Document Has Been Signed on 03/02/2023 04:36 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: MERILOS, SMYRNA
FACILITY NUMBER: 270767399

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
1
2
3
4
Based on record review, the licensee did not comply with the section cited above. Licensee, helper (spouse), and Assistant did not have immunization records against influenza which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
1
2
3
4
Licensee will submit immunization against influenza for her self, helper (spouse), and Assistant to San Jose Regional Office (SJRO) by POC date.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in which infant does not have LIC 9227 on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
1
2
3
4
Licensee will provide LIC 9227 to be completed by parents and will submit a copy of the completed form to San Jose Regional Office (SJRO) by POC date.
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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7


Document Has Been Signed on 03/02/2023 04:36 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: MERILOS, SMYRNA
FACILITY NUMBER: 270767399

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
(g)The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the Licensee did not comply with the section cited above LPA observe the following in the backyard during inspection in the left side of house LPA observed hazardous items ladders, shovels. and hazardous garden tools, paint, and chemicals etc. LPA also observed dog poop, propane tank, wood log near children play area and which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
1
2
3
4
Licensee agreed to remove items including putting a lock in the left side gate and covering open gap between fence and side gate to prevent children in care having assess to hazardous items. Licensee will submit photos to San Jose Regional Office (SJRO) by POC date.
Type B
Section Cited
CCR
102423(a)(2)
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regarless of consent or authorization from the child's authorized representive. These rights include, but are not limited to, the following: (2) to receive safe, healthful, and comfortable accommodations, funishings, and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in Licensee did not have napping cots for day care children to nap. LPA observed two day care children sleeping in the living room couches and one child in a play yard.

which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
1
2
3
4
Licensee agreed to submit proof of purchase of napping cots and photos to San Jose Regional Office (SJRO) by POC date.
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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7