384001977-12-21-2022-05-CC-LGOZ-CMBVU9-20221221154421

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001977
Report Date: 12/21/2022
Date Signed: 12/21/2022 03:44:38 PM

Document Has Been Signed on 12/21/2022 03:44 PM - It Cannot Be Edited

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 FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	14	CENSUS: 3	DATE:	12/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Mirna Sanchez		TIME COMPLETED:	04:00 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

On 12/21/2022 at 12:40PM., Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Mirna Sanchez. Purpose of the inspection was explained and was for an unannounced; Annual Random inspection. Present in facility was the licensee caring for three children (1 preschool age, 2 infant age). Adults have criminal record clearances on file. Licensee’s home is a one bedroom, one bathroom, one level unit. Days and hours of operation are Monday- Friday, 7:00AM- 6:00PM. Daycare areas are: Play Room (Living Room); Kitchen; Bathroom #1; Hallway (Pass through only) and Outdoor play area. Off Limit areas area: Bedroom #1. LPA inspected home, inside and outside, with licensee for health and safety hazards.

At 12:50AM., the following was observed: Facility was maintained orderly, with age appropriate playthings available for the children. Accessible furnishings, toys and books inspected were in good repair. Playroom has child sized table and chairs for activities. Kitchen has several highchairs (with wide base) for food services. Cubbies are located in entry way for storage of children’s belongings. For napping services, LPA observed napping mats and infant cribs (with tight-fitting sheet) in playroom.

At 1:05PM, Based on observations, LPA confirmed loose objects inside napping infant’s crib. Advisory Note: Technical Violation (LIC9102TA) was issued.

LPA observed least one crib available for each infant in care. Bathroom #1 had adequate supplies for hand-washing. Fixtures tested were in operating condition. Safety locks have been installed on cabinets in kitchen and bathroom #1. Off-limit areas have been made inaccessible with child safety gates. Facility had ventilation and lighting. Diaper changing table is located playroom. Per licensee, area is disinfected after each use. Home had functioning telephone; smoke/ carbon monoxide combination detector; and fire extinguisher, 2A:10BC.

At 1:20PM., LPA inspected the outdoor play area. Area is completely enclosed with tall fencing. Playthings inspected were in proper repair. LPA reminded licensee to remove all broken playthings, hazardous plants from yard area. Outdoor play area does not any pools, fishponds, or bodies of water on the premises.

(REFER TO 809C, FOR CONT)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

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 6

Document Has Been Signed on 12/21/2022 03:44 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 1:40PM., Based on record review and interviews, LPA confirmed licensee in not maintaining documentation of each 15 minute review, for napping infants in care. This poses a potential health and safety risk to children in care.
	POC Due Date: 01/04/2023
	Plan of Correction
1 2 3 4	Licensee will document of each 15 minute review, for napping infant infants in care by the due date: 12/28/2022. Proof of correction will be submitted the department by the due date: 1/4/2022.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: 12/21/2022

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)
At 1:35PM, LPA reviewed facility and children’s records. Children’s files were reviewed and included the: Identification of Emergency Information (LIC700); Immunization Records; Notification of Parent’s Rights (LIC995); Notice of Additional Children in Care (LIC9150); and Consent for Medical Treatment (LIC627).

At 1:40PM., Based on record review and interviews, LPA confirmed licensee in not maintaining documentation of each 15 minute review, for napping infants in care.

LPA reminded licensee to complete the required mandated reporter training certification (AB1207). Advisory Note: Technical Violation (LIC9102TV) was issued.

Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid certifications were current expires 2/2023.

Licensee is conducting required emergency disaster drill every six months, with last drill logged on: 10/28/2022.

Required posting are posted in visible location. Posting include the Childcare License, Notification Parent’s Rights (PUB379), and Emergency Disaster Plan (LIC610A).

Per licensee, isolation of ill children is in playroom.

Per licensee, she provides all foods services for children in care. LPA reminded licensee to ensure all children’s meal containers brought by families should be labeled. Per licensee, home does not have any firearms.

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 Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: 12/21/2022

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 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.

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.

During inspection, licensee signed amended complaint report. Copy of report was provided to licensee.

Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Health and Safety Code of Regulations and cited on 809D. Exit interview, plan of correction and report was discussed with Licensee, Mirna Sanchez, and signature of this form acknowledges receipt of these documents.

Notice of Site Visit was provided and must be posted for 30 days.

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

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

LIC809 (FAS) - (06/04)

Page: 6 of 6