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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313619
Report Date: 09/24/2019
Date Signed: 09/24/2019 02:41:34 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:MIRANOVICH, TATIANAFACILITY NUMBER:
304313619
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
09/24/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Licensee, Tatiana MiranovichTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA), Nguyen conducted an unannounced case management inspection due to licensee’s request to increase license capacity from small family child care home to large family child care home. Fire clearance from the Orange County Fire Authority was received and approved for a large family child care home. The regulations for Large FCC Home were reviewed. LPA toured the facility with licensee, Tatiana Miranovich. Present during today's inspection were licensee, licensee’s assistants and 6 day care children, 2 of which were under the age of two years. Currently living in the home are two adults and two minor children. The facility was clean, orderly, and was at a comfortable temperature. A review of adults' records on today's date indicates that all adults live in the home or individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility is a two story home with attached garage, 5 bedrooms, 4.5 bathrooms, living room, dining room, kitchen, office area, loft, covered outdoor patio and fenced backyard. There is a fenced community pool is accessible for residents, the pool is not located close to the facility (several blocks away) and licensee stated she does not plan to use the pool for daycare. The stairs are barricaded with a baby gate. There is fireplace in the home and is barricaded. Off limits area are: entire upstairs bedrooms, upstairs bathrooms, loft, laundry room, garage, and backyard.



There are age appropriate toys and napping equipment on the premises for the ages served. During today's inspection each child was observed to have safe, healthful and comfortable accommodations, furnishings, and equipment. The licensee has a current roster of children in care. Children's records were reviewed and in compliance. The licensee stated that there are no firearms on the premises. LPA advised anytime firearms are present, they must be locked and stored separately from the ammunition. The smoke detector, fire extinguisher, and carbon monoxide detector were present and within regulations. The fire alarm and carbon monoxide detector were functioning during today's inspection. Continued on Page 2
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019
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: MIRANOVICH, TATIANA
FACILITY NUMBER: 304313619
VISIT DATE: 09/24/2019
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The home was in compliance with Title 22 Regulations. LPA informed licensee that a final review of the file will be done before the large family child care license is issued. The licensee will be notified if any corrections or additions need to be completed. Pending review and approval, a large family child care license will be granted.

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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019
LIC809 (FAS) - (06/04)
Page: 3 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: MIRANOVICH, TATIANA
FACILITY NUMBER: 304313619
VISIT DATE: 09/24/2019
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LPA observed CPR & First Aid (exp. 11/2019) are current for the licensee. Current immunization information and mandated reporter training were verified by LPA.



The following were discussed: Individuals who are 18 years of age or older living or working in the home must be fingerprinted cleared prior to being present in the facility. Adults must contact a Live-Scan complete LIC 9163. If adult is fingerprinted cleared and associated to another facility, licensee must complete a Criminal Record Clearances or Exemption Transfer Request form (LIC 9182). Contact Licensing Office (714)703-2800 ask for Personnel ID#, fax Criminal Background Transfer Request form (LIC 9182 or LIC 9188) with copy of ID and Criminal Record Statement (LIC 508) to fax # (714)703-2831 prior to hiring adult.

LPA advised licensee to contact licensing for any changes to hours and days of planned operation, and for any changes to facility, including on/off limit areas and change in phone number. The licensee has a cell phone that is used for child care. The licensee was reminded that if a cell phone is only used, it must remain on the premises always during hours of operation. Licensee was reminded and understands the home is to be free from smoking always.

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 licensee copy of Never Ever Shake a Baby, Safe Sleep and Lead handouts.

The applicant was also informed to visit the www.ccld.ca.gov website for Quarterly Updates. The applicant was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov

Continued on Page 3

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3