434414684-12-16-2021-52-CC-MESA-C9S2G5-20211216162234

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414684
Report Date: 12/06/2021
Date Signed: 12/16/2021 04:22:40 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:	CHEN, LEAH MUZONES		FACILITY NUMBER:	434414684
ADMINISTRATOR:	CHEN, LEAH MUZONES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 963-1990
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	14	CENSUS: 6	DATE:	12/06/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:32 AM
MET WITH:	Leah Muzones Chen		TIME COMPLETED:	12:15 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 Monday, 12/06/2021 at 10am, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required One (1) Year Visit. LPA met with the Licensee Leah Muzones Chen and explained the nature of site visit. Present on this visit were the Licensee's Assistant Provider who is also the Licensee's Spouse, four (4) infants, one (1) preschool child and one (1) school age who is also the Licensee's son. The home’s operating days and hours are Monday through Friday 7:00 AM to 6:00 PM. LPA toured the facility to conduct a Health and Safety Inspection with the Licensee. The home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. The On Limit areas are the napping room, big room assigned as a multi use room, hallway bathroom and the backyard. The backyard is fenced and is used for outdoor activity. Outdoor play equipment was observed to be in good condition and age appropriate. The Off Limit areas are the entire second floor, the kitchen on the first floor, the garage and the outdoor patio which will be inaccessible to children in care by closed and or locked doors and or a fence with visual supervision. There is a gate located at the bottom of the stairs to prevent access to the second story and a gate at the kitchen entry way. The designated isolation area for a child who becomes ill while in care is the outdoor patio. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today. Licensee stated that there were no weapons such as firearms stored on the premises. A fully charged Fire extinguisher was observed. Carbon monoxide and smoke detectors were functioning. Log shows that Disaster Drill was last conducted on 10/29/2021. Licensee stated that she does not transport children at this time but Licensee understands that children cannot be left alone, unattended in parked vehicles at any time. Licensee owns the house and has childcare liability insurance SEE 809 C.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021

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: CHEN, LEAH MUZONES	FACILITY NUMBER: 434414684
	VISIT DATE: 12/06/2021

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Continuation...

Facility's roster of children who are provided care was reviewed. Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, and Immunization.

Licensee and Assistant Provider Lei Chen's files were reviewed, which included records of Criminal Record and Child Abuse Index Clearance, TB clearance, Proof of Immunity against Measles and Pertussis and required Training such as the Online AB1207 Mandated Reporter Training. LPAs reminded Licensee that the Online AB1207 Mandated Reporter Training needs to be renewed every two years. Licensee's Pediatric First Aid and CPR certification expires 02/13/2023. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

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 tools, please send them by email 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/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record 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.

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

There are no deficiencies cited on this visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Leah Muzones Chen.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021

LIC809 (FAS) - (06/04)

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