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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700305
Report Date: 07/09/2021
Date Signed: 07/09/2021 02:39:54 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:MENESES MILLAN, CLAUDIAFACILITY NUMBER:
435700305
ADMINISTRATOR:MENESES MILLAN, CLAUDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 468-1788
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:14CENSUS: 15DATE:
07/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Miriam Chavez & Sirly MolinaTIME COMPLETED:
02:35 PM
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On 7/09/2021 at 10:15am Licensing Program Analyst (LPA) Morgan Pringle met with Assistant Teacher Miriam Chavez and Sirly Molina for an unannounced annual inspection. Present during the inspection were three (3) fingerprint cleared Assistants, Miriam Chavez, Luz Lievano and Sirly Molina and one (1) unfingerprinted adult. There were fourteen (14) preschool children and one (1) infant during the inspection. The Licensee’s home was toured for a health and safety inspection. The operating hours are 8:00am – 6:00pm Monday – Friday.

ON LIMITS AREA: Classroom, Living Room, Bedroom and Backyard


OFF LIMITS AREA: Office, Bedroom/Bathroom and Kitchen
ISOLATION AREA: Living Room

The facility is a single-story home rented by the Licensee. The inside of the home is observed to be neat, clean with ample age appropriate materials for the children that are safe and clean. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Assistant has stated that there no firearms and no pets in the facility.

The home has one (1) fully charged 3A40BC fire extinguisher located in the Classroom. One (1) working carbon monoxide detector in the hallway by the front door of the home and one (1) working smoke detector in the Classroom. LPA observed mounted wall heaters around the home for adequate heat. The heaters are placed up high making them inaccessible to the children in care. The home is equipped with many windows for proper ventilation as well. LPA observed a water table in the back yard which was being supervised by an Assistant.

Cont on 809-C
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
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 5
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: MENESES MILLAN, CLAUDIA
FACILITY NUMBER: 435700305
VISIT DATE: 07/09/2021
NARRATIVE
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At 11:15am LPA obtained the facility roster, the assistants files, and the children’s files. The files and the facility roster were incomplete. The Licensee’s Health and Safety training has been completed and CPR and First Aid training is not with an expiration date of 3/27/2022. All required forms are posted and visible for public view in the classroom.

Assistant was reminded that California Law requires 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 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Assistant that all forms can be downloaded at www.ccld.ca.gov. Assistant was also informed 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.



Deficiencies Cited during Inspection
· Unfingerprinted Adult
· Facility out of Ratio
· All Personnel files missing
· Four (4) children’s files missing
· Incomplete Facility Roster (LIC9040)
· Fire and Disaster Drill log incomplete

Incidental Medical Services (IMS) policy was discussed as well. Assistant was reminded that when any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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.

Assistant is 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 $3,000 per person, per incident. Assistant was reminded of the responsibility as a mandated reporter
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: MENESES MILLAN, CLAUDIA
FACILITY NUMBER: 435700305
VISIT DATE: 07/09/2021
NARRATIVE
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Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six months and documented. The licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

Assistant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

This report was read and given to the Assistant for a signature. There are six (6) deficiencies being cited today. Failure to correct by the plan of correction date will result in a penalty of $50.00 per day. This report shall remain on file for 3 years. Appeal Rights were provided and exit interview conducted. A Notice of Site visit was given and must be posted for 30 days.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: MENESES MILLAN, CLAUDIA
FACILITY NUMBER: 435700305
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/09/2021
Section Cited

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102370(d)(1) (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department
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This requirement was not met as evidenced by: Unfingerprinted adult working at the facility. This poses an immediate risk to the health and safety of the children in care.
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Type A
07/09/2021
Section Cited

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102416.5(d)(1) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time ...(1) Twelve children, no more than four of whom may be infants; or
This requirement was not met as evidenced by:
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There were 14 preschool children and 1 infant present during the inspection. Facility is operating out of ratio. This poses an immediate Risk to the health and safety to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: MENESES MILLAN, CLAUDIA
FACILITY NUMBER: 435700305
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/09/2021
Section Cited

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102417(g)(9)(A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement was not met as evidenced by: Fire Drill log is incomplete with the last drill logged 10/10/2020. This poses a potential health and safety risk to the children in care.
Type B
07/09/2021
Section Cited

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102417(g)(8) Each family child care home shall have a current roster of children ...This requirement was not met as evidenced by: After records review, Facility roster has not been updated with 5 children missing. This poses a potential health and safety risk to the children.

Type B
07/09/2021
Section Cited

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102421(b) The licensee shall maintain, in each child's record, a copy of the emergency information card...This requirement was not met as evidenced by: After records review there are 4 children will missing files. This poses a potential risk to the health and safety of children in care.
Type B
07/09/2021
Section Cited

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102416.1(a) Personnel records shall be maintained on each employee and shall contain the following information: This requirement was not met as evidenced by: After records review, all 4 assisstants do not have completed files. This poses a potential health and safety risk to the children in care.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5