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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313619
Report Date: 08/28/2020
Date Signed: 08/31/2020 09:58:06 AM

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:MIRANOVICH, TATIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(617) 331-8588
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY:14CENSUS: 9DATE:
08/28/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee Tatiana MiranovichTIME COMPLETED:
11:00 AM
NARRATIVE
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An unannounced case management report was initiated on today’s date by Licensing Program Analyst LPA Barajas via facetime. During the Tele Inspection a record review was conducted of the staff personnel and roster. LPA Barajas discovered a staff was not associated to the Home Day care facility.
Upon arrival LPA met with Licensee Tatiana Miranovich, who guided LPA on tour of the home day care due to a Tele Inspection. LPA observed 1 infant and 8 Toddlers playing outside with Staff Karina Toledo. During today’s inspection the facility was operating within its licensed capacity and within compliance of staffing ratios.
During the Tele inspection based on the interview conducted with Licensee Tatiana Miranovich, it has been determined Karina Toledo, started working at the day care on Wednesday 08/26/2020 as an Assistant. Licensee stated mailed in Criminal Background Clearance Transfer Request form (LIC 9182) and contacted office on Thursday 08/27/2020. Karina Toledo is fingerprint cleared, however is not associated to License as of start work date of 08/26/2020 to: Tatiana Miranovich Day Care Facility. Staff Karina Toledo is not associated to the Home Day Care License: Tatiana Miranovich as of 08/28/2020.

California Code of Regulations, Title 22, Division 12, Chapter, Section 102370(d)(2) is being cited on the attached LIC 809D. A civil penalty of $300 has been assessed for Staff Karina Toledo for not being associated to facility as of 08/26/2020.
This report cites a Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC 9224 to be kept in each child's file.
Exit interview was conducted with Licensee Tatiana Miranovich via Tele-Inspection. A copy of the report along with Appeal Rights will be emailed to Licensee with a Read Receipt to acknowledge report was received. If Read Receipt is not functional, Licensee will respond to email stating “I have read and received the report, I acknowledge receipt.” LIC 809 will also be mailed if those options are not available.
End of Report.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2020
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MIRANOVICH, TATIANA
FACILITY NUMBER: 304313619
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/28/2020
Section Cited

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102370(d)(2) Criminal Record Clearance(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (2)Request a transfer of a criminal record clearance as specified in Section 102370(j) or.. This requirement was not met as evidenced by:
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Based on observation, interview and records review: Karina Toledo is fingerprint cleared, however is not associated to License as of start work date of 08/26/2020 to:Tatiana Miranovich Facility. Staff Karina Toledo is not associated to the License: Tatiana Miranovich as of 08/28/2020. This is an immediate risk to the safety of children in care.
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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: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2020
LIC809 (FAS) - (06/04)
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