435700305-8-15-2023-52-CC-MPRE-CUQVLK-20230815163204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700305
Report Date: 08/15/2023
Date Signed: 08/15/2023 04:32:20 PM

Document Has Been Signed on 08/15/2023 04:32 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:	MENESES MILLAN, CLAUDIA		FACILITY NUMBER:	435700305
ADMINISTRATOR:	MENESES MILLAN, CLAUDIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 468-1788
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94306
CAPACITY:	14	CENSUS: 9	DATE:	08/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:36 AM
MET WITH:	Sirly Molina Comas		TIME COMPLETED:	04:30 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 8/15/2023 at 10:36am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee’s assistant Sirly Molina Comas for a Required – 1 Year Inspection. LPA was informed that the Licensee was at a doctor’s appointment with her nephew in San Francisco. Present during the inspection were two (2) assistants, Sirly Molina Comas, Diana Gomez and nine (9) preschool age children. The facility goes by the name Mi Casita de Espanol Preschool. The facility operates 8:30am – 5:00pm, Monday – Friday. ON LIMITS AREA: Classroom (next to driveway), Living Room, Dining Area, 1^st Bedroom on the Right side of the Hallway (currently used for storage), Hallway Bathroom and Backyard OFF LIMITS AREA: 2^nd Bedroom on the right side of the hallway (used as an office), Bedroom on left side of the hallway and Kitchen ISOLATION AREA: Living Room The facility is a single-story home rented by the Licensee. Families use the gate on the right side of the home as the entrance. The inside of the home was observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. Facility Staff stated all food, lunch and snacks, are brought from the children’s home. Facility provides snacks if needed. All food that is brought from the children’s home is properly labeled and stored. All off limit areas are made inaccessible with closed doors. Facility does not be transport children. There are no pets and no firearms in the home.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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: MENESES MILLAN, CLAUDIA	FACILITY NUMBER: 435700305
	VISIT DATE: 08/15/2023

NARRATIVE

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There is one (1) fully charged 3A40BC fire extinguisher in the classroom. There is one (1) working smoke detector in the on-limit bedroom, the office, the hallway, and in the classroom. There is a carbon monoxide detector on the wall by the front door. 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. The electric fireplace in the living room is locked and not in use making it inaccessible to the children in care. LPA did not observe and harmful or unattended bodies of water in or around the home.

The backyard is fully fenced with ample age-appropriate materials for the children. There is a gazebo that is used as an arts and crafts area, water tables, a playhouse and a play structure that is bolted into the ground and has extra cushion underneath for extra safety. The left side of the backyard has a small garden bed and more materials for the children. There is plenty of shade outside for the children as they spend most of their time outside as long as the weather permits.

Licensee’s Health and Safety training has been completed and EMSA approved Pediatric CPR & First Aid is expired. Licensee completed an online training that is not EMSA approved. Licensee’s Mandated Reporter training has also expired. All required forms are posted in the classroom. Fire/Disaster drill is complete with the last drill logged 6/19/2023. All adults working in the home have obtained a criminal record clearance. LPA obtained the facility files, Assistant’s files, and the children’s files. Through record review it was found that all children present had forms from their previous provider on file, one (1) child was missing LIC700 Identification and Emergency, the facility roster was incomplete, Licensee’s CPR & First Aid training was taken online, which is not an EMSA approved course, Licensee and Licensee’s assistant Mandated Reporter training was expired and both assistants had missing/incomplete immunization records.

Deficiencies cited during inspection
· Licensee and assistant Mandated Reporter training certificates are expired
· Licensee’s EMSA approved Pediatric CPR & First Aid training expired
· Facility Roster incomplete
· Assistants’ immunization records are missing/incomplete

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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: MENESES MILLAN, CLAUDIA	FACILITY NUMBER: 435700305
	VISIT DATE: 08/15/2023

NARRATIVE

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Assistant was reminded that California law requires Licensee’s to report unusual incidents and/or injuries to children in care, to the child's parents, and to the Department within 24 hours by phone, fax, or email. Within seven (7) days from the incident, Licensee’s must submit the Unusual Incident/Injury form (LIC 624B) to the Department. Assistant was reminded that any structural changes or additions to the home must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. Assistant was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Assistant was also informed that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting https://mandatedreporterca.com/. LPA informed Assistant that all forms can be downloaded at www.ccld.ca.gov.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Assistant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assistant was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the ASSISTANT Sirly Molina Comas, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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: MENESES MILLAN, CLAUDIA	FACILITY NUMBER: 435700305
	VISIT DATE: 08/15/2023

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LPA discussed the safe sleep regulations with Assistant 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 Assistant 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

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

Exit interview conducted and report was reviewed with the Assistant Sirly Molina Comas.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/15/2023 04:32 PM - It Cannot Be Edited

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: 08/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/18/2023
	Plan of Correction
1 2 3 4	Licensee and Assistant will complete the Mandated Reporter training and send LPA Pringle proof of completion. Licensee will send LPA a written statement on how the facility will ensure that all trainings are kept up to date. Statement and proof of training completeion will be sent to LPA by POC due date.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/21/2023
	Plan of Correction
1 2 3 4	Licensee will complete an EMSA approved Pediatric CPR & First Aid training. If training cannot be completed by POC due date, Licensee will register for a training that will take place in no more than 30 calander days from todays inspection. Proof of training completeion or proof of traning registration must be sent to LPA Pringle by POC due date.

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 Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/15/2023 04:32 PM - It Cannot Be Edited

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: 08/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/18/2023
	Plan of Correction
1 2 3 4	Licensee's assiatnats, T1 and T2 will provide proof of immunzation record for MMr, Tdap. T1 will provide record for missing MMr and T2 will provide record for MMr and Tdap. If records cannot be obtained, Assistants must make appointment with personal physicain to obtain proof of immunity. Licensee will send LPA proof of immunization records or proof of appointment to LPA Pringle by POC due date.

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based onrecord review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/18/2023
	Plan of Correction
1 2 3 4	Licensee will complete facility roster. Completed facility roster must be sent to LPA Pringle by POC due date.

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 Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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