444412306-6-20-2022-07-CC-CNEN-CFKPZ7-20220620114505

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444412306
Report Date: 06/20/2022
Date Signed: 06/20/2022 11:45:16 AM

Document Has Been Signed on 06/20/2022 11:45 AM - 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CLELAND, MICHELLE		FACILITY NUMBER:	444412306
ADMINISTRATOR:	CLELAND, MICHELLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 254-5113
CITY:	LA SELVA BEACH	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 10	DATE:	06/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Michelle Cleland		TIME COMPLETED:	11:55 AM

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), Cortney Nelson, met with Licensee, Michelle Cleland, for an unannounced Required- 1 Year Inspection. LPA was granted access to the home by the Licensee and toured both indoors and outdoors during the inspection. Upon arrival, there were 10 preschool-age children, Assistant, Linda Rivas, and Licensee present, which is compliant with the home license capacity and ratio requirements. LPA observed all required postings near the entrance to the home. LPA advised Licensee that required postings must be maintained near the entrance of the facility. Hours of operation are Monday – Thursday, 8:00AM-1:00PM. Licensee states that adults, over the age of 18, residing in the home are: herself, and her home renters (Cedar & Mara Milazzo). All adults residing in the home have Criminal Background Check Clearance and signed Criminal Record Statements (LIC508). Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. LPA reviewed facility roster (LIC9040) and fire/disaster drill log during todays inspection. The last fire/disaster drill was conducted on 6/8/2022, which is compliant with the six-month requirement for homes. LPA observed a fully charged 3A40BC fire extinguisher, functioning smoke detector and carbon monoxide detector. Licensee states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. The Licensee states that there are no weapons or firearms in the home. Licensee has current liability insurance through Next First Insurance Agency, Inc that expires 8/2023.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

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: CLELAND, MICHELLE	FACILITY NUMBER: 444412306
	VISIT DATE: 06/20/2022

NARRATIVE

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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 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

Indoor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Off-limits areas include: entire main house (separate from the day care building) and upper loft area used for storage. Ladder leading to storage area is properly barricaded so children cannot access it. Licensee has plug in heater that appears as an electric fireplace, however does not get hot to the touch. Heater is located on 3 ft tall table and portion where hot air comes out is approximately 5 ft off the ground, inaccessible to children. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. Drinking water is readily available for children in the facility via water bottles from home labeled with the children’s names. Children at the preschool bring food from home and snack is provided by the facility. The bathroom in the home is clean, sanitary, and operable. The Licensee has a working telephone in the facility.

The backyard area of the home was inspected. LPA observed sufficient play-equipment and supplies for the children that are age-appropriate. Licensee states that the facility will be closed during the month of July and during that time outside area will be relocated to the front yard. LPA advised that playground equipment used for the children must be securely fastened to the ground and plastic climbing structures should be cleaned off. One playground structure is broken and ducted taped back together, LPA advised this structure should no longer be used for children. Off-limit areas outside of home include: storage building and all area outside of fenced in area for children. No outdoor bodies of water were observed during todays inspection.

Licensee does not care for infants, however LPA discussed the safe sleep regulations with licensee 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.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

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: CLELAND, MICHELLE	FACILITY NUMBER: 444412306
	VISIT DATE: 06/20/2022

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10 children’s files were reviewed during todays inspection and all required documents were present, including Notification of Additional Child in Care (LIC9150). Licensee, Assistant, and Home Renter files were reviewed and most required documents were present. There is at least one staff member present with current CPR/First-Aid that expires 8/18/2023. The Licensee has current Mandated Reporter Training that expires on 5/10/2024 and LPA reminded that both trainings must be renewed every 2 years.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The Licensee states that she does not transport any day care children. LPA reminded Licensee that children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Exit interview conducted and report was reviewed with the Licensee, Michelle Cleland.

As a result of todays inspection, deficiencies were cited, see 809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/20/2022 11:45 AM - 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CLELAND, MICHELLE	FACILITY NUMBER: 444412306
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(d)

102417 Operation of a Family Child Care Home (d) The home shall provide safe toys, play equipment and materials. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above for outside play equipment (playground needs to be bolted to ground, broken equipment should be repaired or removed, plastic equipment should be washed off) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/24/2022
	Plan of Correction
1 2 3 4	Licensee will bolt playground to the ground, remove or repair broken equipment, and clean off plastic play structures by 6/24/2022 and submit photos of outside space. LPA advises inspection upon completion of new outside space to be utilized in the fall prior to children's use.

Type B

Section Cited

CCR

102369(b)(9)

102369 Application for Initial License (b) The applicant shall provide... (9) Evidence of a current tuberculosis clearance, not more than one year prior or seven days after initial presence in the home, for any adult home during the time children are in care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in for 3 out of 4 adults in the home, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/30/2022
	Plan of Correction
1 2 3 4	Licensee will submit proof of tuberculosis test for her assistant, Linda Rivas, and renters, Cedar & Maralinda Milazzo) by 6/30/2022. If TB test is past test, it must be within one year of initial presence in the home.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

LIC809 (FAS) - (06/04)

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