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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415875
Report Date: 02/20/2020
Date Signed: 02/20/2020 04:12:52 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, RICHEREFACILITY NUMBER:
434415875
ADMINISTRATOR:RICHERE MONIMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 659-1808
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:14CENSUS: 1DATE:
02/20/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:08 PM
MET WITH:Monima, RichereTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Almaraz, Araceli conducted a one year required inspection. LPA met with Licensee, Monima, Richere and explained the nature of today's inspection. Present during the inspection was the licensee, Monima, Richere. There was one child present, licensee's preschool child. 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. There are three minors residing in the home.
Physical Plant:
LPA inspected the indoor and outdoor areas of the home today. 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. LPA observed a barricaded fireplace. Licensee states that there are no weapons in the home. LPA did not observe any bodies of water inside or outside the home. Medication, cleaning products and similar items are stored inaccessible to children. Poisons are locked. Licensee has one pet, vaccinated. LPA did not observe any heaters in the home.
Facility Records: Licensee Monima has CPR and First Aid, which has an expiration date of 11/15/2021. LPA Almaraz observed that the Licensee has record of MMR & Tdap vaccinations as well as the opt out form for the flu vaccine. LPA observed a current roster, a current fire disaster/earthquake drills last log 01/31/2020. Licensee has day care insurance **Page 1/2
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
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 2
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: 02/20/2020
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Licensee Momima completed Mandated Reporter Training on 04/13/2018, licensee understands training is to be completed every two years. LPA Almaraz 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 a working smoke/carbon monoxide detector, 2A10BC fire extinguisher, last serviced 03/21/2019. Licensee Monima understands the following: A cleared adult must be present in the home during day care hours. Children must be supervised at all times. The capacity options and ratio requirements. Not 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 A review of staff records on 02/20/2020 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

LPA Almaraz conducted an exit interview and advised licensee Monima of the pending Department regulations update re: safe sleep for infant children. Department website: www.ccld.ca.gov for additional information. LPA discussed the requirements of AB633 to Licensee. There are no deficiencies during today’s inspection.

NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 DAYS.**Page 2/2

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
LIC809 (FAS) - (06/04)
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