434414684-11-2-2022-52-CC-MESA-CKSSST-20221102140828

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414684
Report Date: 11/02/2022
Date Signed: 11/02/2022 02:08:39 PM

Document Has Been Signed on 11/02/2022 02:08 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, 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:	11/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:27 PM
MET WITH:	Leah Chen		TIME COMPLETED:	02:15 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 Tuesday, November 1, 2022 at 1 pm, 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, two (2) infants, three (3) preschool children and one (1) school age child, 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 is a two (2) story home. 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. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector and working telephone. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 06/15/2022. Licensee owns the house and has childcare liability insurance with State Farm. 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: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

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: 11/02/2022

NARRATIVE

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Continuation.

The licensee and licensee's assistant's CPR and First Aid certificate and expires on 02/13/2023. The licensee completed the Mandated Reporter General Training and Child Care Providers training online at https://mandatedreporterca.com/ on 12/17/2021. Licensees have records of Measles and Pertussis immunization, Influenza vaccination and TB clearance. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

Facility roster of children was reviewed, and a copy was obtained. Children’s files were reviewed, which included but not limited to records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, LIC 9150, LIC 282, Sleep Logs and Immunization. The licensee is in ratio today.

Licensee stated that she does not transport children at this time. Licensee has a current and valid Driver License. Licensee understands that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children in care shall be maintained in safe operating conditions and all vehicle occupants must be secured in an appropriate restraint system.

Incidental Medical Services (IMS) policy 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 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

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.

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: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

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: 11/02/2022

NARRATIVE

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Continuation.

LPA Estoesta discussed and provided copies of the following;

1. Provider Information for Parents & Families about Lead Poisoning and reminded that licensee must provide the Risks and Effects of Lead Poisoning PUB 515 flyer to parents and families upon enrolling or reenrolling.
2. Guardian User Information.

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 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 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.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

There are no deficiencies cited on this visit.

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

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

LIC809 (FAS) - (06/04)

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