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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311860
Report Date: 07/01/2019
Date Signed: 07/01/2019 04:00:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MARESCA, MA. TERESA AND MARESCA, LINDAFACILITY NUMBER:
304311860
ADMINISTRATOR:MARESCA, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 770-7043
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:14CENSUS: 7DATE:
07/01/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Linda MarescaTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA), Han conducted an unannounced annual/random inspection of the facility on today's date. LPA Han toured the facility with the licensee, Linda Maresca and a census taken. Observed was licensees, licensee’s grandsons: three teenagers, seven children, three who were under the age of two. Children were napped during the inspection. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The LPA toured the facility inside and outside. Medication storage, 1st aid kit, and cleaning supplies storage were inspected. Facility met all posting requirement. The facility clean and in good repair, hazards inaccessible or locked, and fire place screened. Stairs were not barricaded when LPA enters the facility. Licensee had Type A violation for not barricading stairs in 8/2017. There are age appropriate toys and equipment on the premises. The required fire extinguisher (2A10BC), carbon monoxide, and smoke detectors are in operable condition. Per Licensee there are no weapons in the facility at this time. Licensee stated off limit areas include: entire upstairs and garage. Facility files were reviewed, including facility roster and fire and disaster drill log. Both roster and drill log were not updated upon request.

Licensees records were reviewed, including, TB test, immunization records (Measles, Pertussis, and Influenza), Criminal Record Statement, and current CPR and First Aid. Both licensees’ immunization records has not been submitted to licensing office since 8/2/2017 inspection. Mandated Reporter Training Certificates were not available to review at the time of the facility inspection.
Seven children’s records were reviewed, including, Notification of parents’ rights, Parent notification additional children in care, Parent notification additional children in care, Identification and Emergency information, Consent for emergency medical treatment, and Affidavit regarding liability insurance for family child care home. Child#5, #6, and #7 did not have consent for emergency medical treatment (LIC627).
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MARESCA, MA. TERESA AND MARESCA, LINDA
FACILITY NUMBER: 304311860
VISIT DATE: 07/01/2019
NARRATIVE
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Licensee is current with Pediatric CPR and First Aid and both valid until 1/2020. Licensee was reminded that licensee must present at facility and ensure that children are properly cared for and supervised at all times. Licensee must make sure that a substitute adult cares for the children when licensee is temporarily absent. The licensee was also reminded that no child shall be left alone in a parked vehicle at any time.

Licensee does not provide Incident Medical Services.
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

Based on LPAs observations, record reviews, and interviews the following violations were observed are being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 102417(g)(9)(A)(1),102417(g)(3), 102417(g), 102417(g)(7) and Health and Safety 1596.866(b)(1), 1597.622(a)(1). Please refer to attached 809D for documentation of deficiencies.

The following was discussed with licensee: Providers guide to Safe Sleep, Never Shake a Baby, Ratio and Capacity, Quarterly updates, Advocate program contact, 25 E-learning Modules, Mandated Reporter training, Criminal record clearance, Unusual Incident Report (LIC624B), AB 2084 (Nutritious Beverages), Immunization for staff, Indoor/Outdoor activity space equipment condition, Lead exposure information, California Child Passenger Safety Law, Supervision. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf. The below links offer more information on safe sleep to our providers
https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

No smoking on premises, infant walkers, bouncers, Johnny jumpers, exersaucer or any other similar items that fall into that category are allowed in the facility.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MARESCA, MA. TERESA AND MARESCA, LINDA
FACILITY NUMBER: 304311860
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)(1)
Facility Administration
102417(g)(9)(A)(1) Operation of a Family Child Care Home. (1)The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with licensee, licensee fail to ensure to document the fire and disaster drill log.
This poses a potential Safety risk to the children in care.
POC Due Date: 07/31/2019
Plan of Correction
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The licensee will practice drill again and update drill log and submit its proof by email.
JUNGMI.HAN@DSS.CA.GOV
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2019
LIC809 (FAS) - (06/04)
Page: 5 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MARESCA, MA. TERESA AND MARESCA, LINDA
FACILITY NUMBER: 304311860
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(3)
Facility Administration
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.
Deficient Practice Statement
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Based on observation, the stairs were not gated upon arrival into the facility. This poses an immediate Health and Safety risk to the children in care.
POC Due Date: 07/01/2019
Plan of Correction
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During the inspection, the licensee gated the stairs. Licensee understands that stairs are to remain gated at all times, while children under 5 years old are in care.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2019
LIC809 (FAS) - (06/04)
Page: 3 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MARESCA, MA. TERESA AND MARESCA, LINDA
FACILITY NUMBER: 304311860
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
Records
(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.
Deficient Practice Statement
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The licensees did not have proof of immunization against pertussis and measles available for review. LPA requested licensee's immunization on 8/2/2017 during annual inspection. Llicensee did not submit its proof to licensing office. This poses a potential Health and Safety risk to the children in care.
POC Due Date: 07/31/2019
Plan of Correction
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Licensee will submit both licensee's immunization records (pertussis and measles) to LPA by due date.

JUNGMI.HAN@DSS.CA.GOV
Type B
Section Cited
CCR
102417(g)(7)
Facility Administration
102417(g)(7) Operation of a Family Child Care Home (7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
Deficient Practice Statement
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Based on record review, licensee fail to ensure to maintain Child#5, 6, and 7’s consent form for emergency medical care. This poses a potential Safety risk to the children in care.
POC Due Date: 07/31/2019
Plan of Correction
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Licensee will submit child#5, child#6, and child#7's consent form for emergency medical care (LIC 627) by email by due 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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2019
LIC809 (FAS) - (06/04)
Page: 4 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MARESCA, MA. TERESA AND MARESCA, LINDA
FACILITY NUMBER: 304311860
VISIT DATE: 07/01/2019
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An exit interview was completed. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. If the facility receives a Type A violations, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days, and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file.

Any proposed changes to the physical plant, including telephone number, shall be immediately reported to the Department.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2019
LIC809 (FAS) - (06/04)
Page: 7 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MARESCA, MA. TERESA AND MARESCA, LINDA
FACILITY NUMBER: 304311860
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Physical Plant - 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:

Deficient Practice Statement
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Based on observation, cat food dish were available on the kitchen floor where child can access. This poses a potential Health and Safety risk to the children in care.
POC Due Date: 07/31/2019
Plan of Correction
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The licensee will find other place where children cannot access, but cat can access food. The licensee will submit proof by picture by due date.

JUNGMI.HAN@DSS.CA.GOV
Type B
Section Cited
HSC
1596.8662(b)(1)
Facility Administration - 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.

Deficient Practice Statement
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Based on observation, the licensee failed to complete mandated reporter training certificate. This poses a potential Health and Safety risk to the children in care.
POC Due Date: 07/31/2019
Plan of Correction
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The licensee will submit two certificates for both licensess by due date by email.
JUNGMI.HAN@DSS.CA.GOV
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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2019
LIC809 (FAS) - (06/04)
Page: 2 of 7