435700341-10-27-2021-52-CC-JWIS-C87PLP-20211027112503

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700341
Report Date: 10/27/2021
Date Signed: 10/27/2021 11:25:14 AM

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:	CORONA HEREDIA, OSCAR		FACILITY NUMBER:	435700341
ADMINISTRATOR:	CORONA HEREDIA, OSCAR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 630-9010
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94301
CAPACITY:	14	CENSUS: 0	DATE:	10/27/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Oscar Corona Heredia		TIME COMPLETED:	11:40 AM

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On 10/27/2021 at 9:00am Licensing Program Analyst (LPA) Jonathan Williams met with Applicant, Oscar Corona Heredia, for the purposes of conducting an announced prelicensing inspection (change of location). Present during today's inspection was the Applicant only. All adults living in the home are fingerprint cleared and associated. The home was toured to conduct a health and safety inspection.

On-limit-areas: Room 1, room 2, bathroom, front yard, back yard.
Off-limit-areas: Kitchen, room 3, fenced off area of the backyard, side yard furthest from the cross street.
Isolation area: Room 2.

The interior of the facility was toured at 9:05am. The facility is a 1-story home located in a duplex rented by the Applicant that consists of two main rooms used for daycare, one bedroom, bathroom, front yard, and backyard. The home is neat and clean. All toxins, medications, hazardous materials, and cleaning compounds were observed to be made inaccessible to children at the time of this inspection. There is neither a fireplace nor woodstove located in the home. Per Applicant statement, there are no firearms kept in the facility. Per Applicant statement, there are no pets kept in the home. Per Applicant statement, nobody smokes in the facility.

The other unit in the duplex (259 Webster Street, Palo Alto, CA 94301) is also a licensed Family Child Care Home (license number 434415784) operated by licensee Maria Heredia Anton. Per Applicant, Maria Heredia Anton is the mother of Applicant. LPA advised Applicant that children enrolled at his facility must be kept physically separate from children enrolled at the neighboring facility at all times. LPA advised Applicant that failure to do so may result in citations and civil penalty assessments.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021

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: CORONA HEREDIA, OSCAR	FACILITY NUMBER: 435700341
	VISIT DATE: 10/27/2021

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Applicant tested carbon monoxide and smoke detectors and LPA observed them to be functional at 9:15am. A 3A40BC fire extinguisher was observed at 9:24am to be located near the kitchen. A fully stocked first aid kit was observed to be located in "room 2" at 10:35am.

The backyard was toured at 9:30am. The backyard was observed to be free of dangerous and age-inappropriate items and furnishings at this time. Climbing equipment was observed to have cushioning material to absorb falls. Per Applicant statement, there are no pools, ponds, hot tubs, or any other bodies of water on the facility premises at this time.

Applicant has required Preventive Health and Safety Training certificate, including lead poisoning prevention update. Applicant has current CPR/1st Aid certificate which expires on 09/30/2023. Mandated Reporter training certificates for Applicant are current, and expire on 12/9/2022. The facility sketch matches the home. Thorough guidance regarding COVID-19 policies and procedures was provided. Facility has fire clearance granted by Palo Alto Fire Department on 10/19/2021.

Applicant 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 $3000 per person, per incident. Applicant was reminded of the responsibility of a mandated reporter.

Applicant was reminded that California Law requires licensed Family Child Care Home 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 624b). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the Licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Applicant was also reminded 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.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021

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: CORONA HEREDIA, OSCAR	FACILITY NUMBER: 435700341
	VISIT DATE: 10/27/2021

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Incidental Medical Services (IMS) policy was discussed at 11:14am. Applicant was reminded that when any IMS is provided, a 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.

The Applicant is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

This home is recommended for a license for a large Family Child Care Home effective 10/27/2021.

Appeal Rights provided. Exit interview conducted at 11:16am.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021

LIC809 (FAS) - (06/04)

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