434414247-9-2-2021-52-CC-JWIS-C6GVWA-20210902164737

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414247
Report Date: 09/02/2021
Date Signed: 09/02/2021 04:47:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	CORONA, ESTHER & CHAKMAKCHI, MOHAMED		FACILITY NUMBER:	434414247
ADMINISTRATOR:	CORONA, ESTHER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 739-5962
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94301
CAPACITY:	14	CENSUS: 8	DATE:	09/02/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Esther Corona		TIME COMPLETED:	04:45 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 9/2/2021 at 3:10pm, Licensing Program Analyst (LPA) Jonathan Williams met with co-Licensee Esther Corona for a Required 1 Year Inspection. Present for this inspection are the co-Licensee, two fingerprint cleared and associated staff members, and eight children in care (one infant and seven preschoolers). The facility was toured to conduct a Health and Safety Inspection. The home is a 1 story home and is tidy and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are living room, kitchen, bedroom 1, bathroom next to bedroom 1, indoor patio, outdoor patio, and backyard. The OFF LIMIT AREAS are bedroom 2, bathroom next to bedroom 2, and bedroom 3, all of which will be made inaccessible to children by closed and/or locked doors, barricade, and visual supervision. The ISOLATION ROOM is the living room. There are toys and learning materials in the facility. The backyard is fenced and contains a wooden play/climbing structure which is surrounded by cushioning material to absorb falls at the time of this inspection. There are no pools, hot tubs, ponds, or any other bodies of water in the on-limits areas during today's inspection. All hazardous materials and toxins were observed to be made inaccessible to children during today's inspection. Per Licensee, there are no firearms kept in the home. There is no fireplace in the home. The facility has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Licensee has current CPR/1st Aid training which expires on 8/21/2023. Mandated Reporter Training for Licensee expires on 9/1/2023. Mandated reporter trainings for both assistants are current. The facility is in ratio today. Children's files and staff files were reviewed for proper documentation. Facility roster was obtained. The facility conducts fire/disaster drills once every 6 months.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CORONA, ESTHER & CHAKMAKCHI, MOHAMED	FACILITY NUMBER: 434414247
	VISIT DATE: 09/02/2021

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Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. Facility is following IMS plan on file. When any changes to the IMS plan is made, an updated 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/childqanda.htm.”

Licensee was reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.
Licensee was reminded that California Law requires licensed Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624b). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the Licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

There are no deficiencies cited. This report shall remain on file for 3 years. A Notice of Site Visit was provided to the Licensee. LPA reminded the Licensee to post the Notice of Site Visit where it is clearly visible inside the facility for 30 days. Appeal rights were provided to the Licensee. Exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

LIC809 (FAS) - (06/04)

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