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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001977
Report Date: 02/01/2022
Date Signed: 02/01/2022 11:56:13 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SANCHEZ, MIRNA D.FACILITY NUMBER:
384001977
ADMINISTRATOR:SANCHEZ, MIRNA D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 641-8426
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:14CENSUS: 4DATE:
02/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mirna SanchezTIME COMPLETED:
12:05 PM
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On 2/1/2022 at 9:00A.M. Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Mirna Sanchez. Purpose of the inspection was explained and is for an unannounced, Annual/Random inspection. Present was the licensee and caring for four children. (2 Infant Age, 2 Preschool Age). Licensee’s home is a one bedroom, one bathroom, one level unit. Days and hours of operations are, Monday – Friday, 6:00 A.M., to 6:00 P.M. Day-care Areas: Living Room (Playroom), Bathroom #1, Kitchen and Outdoor Play Area. Off-limit Areas: Bedroom #1. LPA inspected home, inside and outside, with licensee for health and safety hazards.

At 9:05A.M., LPA observed the following: Day-care was orderly with variety of age appropriate toys and blocks for the children. Furniture and playthings inspected were in good repair. Cubbies were located in hallway for children’s belongings. Fireplace in playroom was barricaded. Floor in playroom was carpeted for added safety. For napping services, infant cribs and cleanable mats are located facility playroom. Per licensee, napping supplies and sheets are cleaned weekly. Bathroom #1 was maintained clean with adequate supplies for the children. Bathroom fixtures were in operating condition. Licensee has installed child safety locks on cabinets in the kitchen area and bathroom #1. LPA observed kitchen has child size tables and chairs for snack. Facility was the proper temperature with adequate ventilation and lighting. Off-limit areas have been made inaccessible with child safety gates and locks. LPA observed cleaned detergents, compounds and other items which could pose a danger, stored in an off-limit area. Home had a functioning telephone, smoke / carbon monoxide detector and fully charged fire extinguisher (3A:40BC), located in the kitchen.

At 9:40A.M., LPA inspected the Outdoor Play Area. Area was completely enclosed with tall fencing. LPA observed a shaded rest area available to the children. Per licensee, drinking water is made available to children at all times. LPA reminded licensee to remove any broken toys/ equipment from area as necessary. Area did not have swimming pools, spas, hot tubs, fishponds or any other accessible bodies of water. (REFER TO 809-CFOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SANCHEZ, MIRNA D.
FACILITY NUMBER: 384001977
VISIT DATE: 02/01/2022
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(Page 2)

At 9:55A.M., LPA conducted facility records and children’s files. Children's records included: (LIC700) Identification of Emergency Information (LIC700), Consent for Medical Treatment (LIC627) and Notice of Parent's Rights (LIC995b)

At 10:00A.M. Based on record review, LPA confirmed licensee missing proof of updated immunization record in child's file (S2). During inspection, Advisory Note: Technical Violation (LIC9102TV) was issued.

At 10:20AM., Based on record review, LPA confirmed, required Individual infant sleep plans (LIC9227) were missing from two qualifying children’s files. During inspection, Advisory Note: Technical Violation (LIC9102TV) was issued.

LPA reminded licensee to document each health check, every 15 minutes during nap time for all infants in care. Facility is conducting required Emergency Disaster Drill every 6 months, with the last drill properly logged on 1/2/2022. Children's Roster was properly updated by licensee during inspection. Licensee’s CPR/1st aid certification is current and expires on, 2/2023.

LPA reminded licensee to complete the mandated reporter training certification for childcare providers every two years. LPA observed required forms visibly posted in facility hallway Posted forms including the Facility License, Emergency Disaster Plan, and Parent’s Rights. Licensee stated she provided all daily snacks and meals. Per licensee, no children in care require IMS. LPA reminded licensee to ensure all children food containers brought from home are labelled. Per licensee, there are no guns or weapons in the home.

Licensee was reminded that all adults 18 years and over living or working in the home, including employee and volunteers, must obtain criminal 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. (REFER TO 809C FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SANCHEZ, MIRNA D.
FACILITY NUMBER: 384001977
VISIT DATE: 02/01/2022
NARRATIVE
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(Page 3)

LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) 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 Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tool, please send them to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were cited in areas evaluated according to California Title 22, Health and Safety code of Regulations. Exit interview was conducted with Licensee, Mirna Sanchez, and her signature of this form acknowledges receipt of these documents. Notice of Site Visit was provided and must be posted for 30 days.



>This report and rights to comment and appeal were discussed with licensee. This report must be available in the facility for public review. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Websit
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5