304312089-5-21-2019-06-CC-STOE-BCDTBS-20190521143537

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304312089
Report Date: 05/21/2019
Date Signed: 05/21/2019 02:35:44 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:	MORENO, DAISY		FACILITY NUMBER:	304312089
ADMINISTRATOR:	MORENO, DAISY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 495-8275
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	14	CENSUS: 5	DATE:	05/21/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Daisy Moreno, licensee		TIME COMPLETED:	03:00 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	An inspection was conducted at the facility by Licensing Program Analysts (LPAs) Mila Quinto and Stacy Torrence. The LPAs toured the facility with licensee, Daisy Moreno. Licensee's assistant, Jeannine Arreguin arrived at 12:15pm. A review of adult records indicates that all facility residents, staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are presently 2 adults including the licensee and 3 children living in the home. An updated 279B was obtained during today's inspection. During today's inspection the home and grounds were toured and the licensee was operating within the licensed capacity. There were 1 infant and 5 preschool age children in care. Also present assisting with the day care children was the licensee's assistant. Operating hours are 7am - 6pm, Monday through Friday. This is a one story with three bedrooms and two bathroom home. The floor plan was verified. The off limits areas are the front yard, three bedrooms, bathroom located in the hallway, kitchen, dining area by means of baby gates, door locks and latches on the kitchen drawers. The licensee use the den/play room, living room, one bathroom and the backyard for outside play area. The outdoor area is free from hazards. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. The licensee stated poisonous items are not stored on site, and none were observed during today's inspection. The home provides safe toys, equipment , and materials. During today's inspection each child was observed to have safe, healthful and comfortable accommodations, furnishings, and equipment. There is a working carbon monoxide detector, smoke detector, and fire extinguisher in the home that meet statutory and State Fire Marshall standards. The licensee has a current roster of children in care. The facility has conducted an emergency drill within the past six months. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

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 3

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: MORENO, DAISY	FACILITY NUMBER: 304312089
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/21/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/14/2019 Section Cited HSC 1597.622	1 2 3 4 5 6 7	1597.622(a) (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.	1 2 3 4 5 6 7	Per licensee's assistant has a doctor's appointment in a few days and will obtain record and will submit copy by POC date.
	8 9 10 11 12 13 14	The requirement is not met as evidence by: The licensee's assistant was unable to show proof of the immunization immunity against measles. This poses a potential health and safety risk to children in care. This poses a potential risk to the health of the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: MORENO, DAISY	FACILITY NUMBER: 304312089
	VISIT DATE: 05/21/2019

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

Page 2

The licensee's pediatric CPR/First Aid Certificate expires on 5/18/21. Licensee's assistant doesn't have current CPR/First Aid Certificate. Children's records were reviewed and in compliance. Licensee have proof of immunization against pertussis and measles and against influenza (written decline). Licensee's assistant is missing proof of immunization for measles and TB. Licensee has completed the required mandated reporter training and provided a copy of certificate to LPAs.

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/childganda.htm.

LPA provided the licensees with the copy of Safe Sleep and Lead handout.

Licensee was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov.

The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today 102416(c) Personnel Requirements and Health and Safety Code 15, see LIC 809D and LIC 9102 for Operations of a Family Child Care Home and childrens immunization was not recorded on the blue card.

Inspection, report review and exit interview was conducted Notice of Site Visit was posted during the visit. 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. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. First level should be sent to the regional manager to the address listed above. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3