434415875-8-8-2019-07-CC-AALZ-BEURPX-20190808131240

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415875
Report Date: 08/08/2019
Date Signed: 08/08/2019 01:13:51 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	MONIMA, RICHERE		FACILITY NUMBER:	434415875
ADMINISTRATOR:	RICHERE MONIMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 659-1808
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	14	CENSUS: 8	DATE:	08/08/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Monima, Richere		TIME COMPLETED:	01:06 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	Licensing Program Analyst (LPA) Almaraz, Araceli conducted an annual random inspection. LPA met with Licensee, Monima, Richere and explained the nature of today's inspection. Present during the inspection was the licensee, assistant Taylor, Katherine and visitor Garcia, Guadalupe. There were eight children present, two infants and six toddlers. The hours of operation of the day-care are 7:30 AM to 5:30 PM, Monday through Friday. There are four adults residing in the home Licensee, spouse Monima, Roger, sister Giasson-Gomez, Eugenie and spouse Gomez, Guillermo. Visitor Garcia, Guadalupe is the mother of Gomez, Guillermo. There are also three minors residing in the home. LPA and licensee discussed requirements for visitors and/or volunteers in the home. LPA referred licensee to the following sections and regulations: Section 1596.871(a)(5) of the Health and Safety Code, Family Child Care Homes, Criminal Record Clearance section 102370 and Personnel Requirements section 102416. Licensee and assistant have CPR and First Aid, which has an expiration date of 10/2019 and 11/2019. LPA reviewed ten children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. LPA observed that the Licensee and assistant have record of MMR & Tdap vaccinations as well as the flu vaccine. Assistant has opted out of the flu vaccine. LPA and licensee discussed requirements regarding immunization's for licensee and assistants. LPA referred licensee to Health and Safety Code Section 1596.866 section (a) that discusses immunization's. LPA observed a working smoke/carbon monoxide detector, 2A10BC fire extinguisher and no bodies of water were observed. Report Continued on Page 2*****

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MONIMA, RICHERE	FACILITY NUMBER: 434415875
	VISIT DATE: 08/08/2019

NARRATIVE

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LPA inspected the indoor and outdoor areas of the home today. LPA did not observe any heaters in the home. LPA observed a barricaded fireplace. Off limit areas in the home are as follows; Master bedroom/bathroom, two bedrooms, laundry room and garage. All off limit areas are made inaccessible by safety knobs, safety locks and/or gates. Off limit areas outside the home are as follows: Right and left side of the yard made inaccessible with gates. The front yard is safety compliant and backyard is fully fenced. All areas are safety compliant.

Medication, cleaning products and similar items are stored inaccessible to children. Poisons shall be locked. LPA observed a current roster, a current fire disaster/earthquake drills last log 06/2019. Licensee states that there are no weapons in the home. Licensee has one pet, vaccinated. Licensee has day care insurance. Licensee completed Mandated Reporter Training on 04/2018, licensee understands training is to be completed every two years.

Supervision of the children was discussed; the Licensee understands a cleared adult must be present in the home during day care hours. Licensees understand that the children must be supervised at all times. The Licensee understands the capacity options and ratio requirements. Licensee understands not to leave children in the car unattended. The Licensee states that there is no transporting of children currently.

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

Report Continued on Page 3*****

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MONIMA, RICHERE	FACILITY NUMBER: 434415875
	VISIT DATE: 08/08/2019

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A review of staff records on 08/05/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.

Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

There are no deficiencies during today’s inspection.

LPA conducted an exit interview with the Licensee and advised the licensee of the pending Department regulation update re: safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information. LPA discussed the requirements of AB633 to Licensee.

NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 DAYS.

Report Continued From Page 2*****

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

LIC809 (FAS) - (06/04)

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