013423297-4-6-2023-52-CC-MPRE-CQMVLU-20230406163232

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423297
Report Date: 04/06/2023
Date Signed: 04/06/2023 04:32:41 PM

Document Has Been Signed on 04/06/2023 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:	VELEZ, MARIA		FACILITY NUMBER:	013423297
ADMINISTRATOR:	VELEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 776-3713
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94545
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 7	CENSUS: 3	DATE:	04/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:24 PM
MET WITH:	Maria Velez		TIME COMPLETED:	04:31 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 4/6/2023 at 2:23pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Maria Velez for an Unannounced 1-Year Inspection. Present during the inspection was the Licensee, her twelve (12) year old foster child, one (1) preschool age child and two (2) infants. Licensee lives in the home with her foster daughter. Licensee’s home was toured for a health and safety inspection. The facility operates from 7:00am – 6:00pm, Monday - Friday. ON LIMITS AREA: Living Room, Kitchen, Hallway Bathroom, 1^st Bedroom on the Right, Detached Converted Garage, Enclosed Patio, Front Yard and Backyard OFF LIMITS AREA: Master Bedroom with Bathroom, 2^nd Bedroom on the Right, Pool Area, Two Bedroom dwelling next to the Pool Area ISOLATION AREA: Living Room or Enclosed Patio There is a new two bedroom dwelling next to the swimming pool area behind the home. There are no bathrooms and each room has a smoke detector. The dwelling is off-limits and gated making it inaccessible to the children in care. LPA reminded Licensee that any additions to the property must be reported to the Department. Licensee will send LPA new facility sketch and city permit. The facility is a single-story home owned by the Licensee. The inside of the home was observed to be neat, clean with ample age appropriate materials for the children. All toxins, cleaning products, medications and hazardous materials were observed to be in inaccessible areas. Licensee provides all food for the children. All food that is brought from the children’s home will be properly labeled and stored. All napping equipment is clean and well maintained. Licensee stated that she does not transport children. There are no pets and no firearms in the home.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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: VELEZ, MARIA	FACILITY NUMBER: 013423297
	VISIT DATE: 04/06/2023

NARRATIVE

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There is a fully charged 3A40BC fire extinguisher on the kitchen counter next to the refrigerator and in the converted garage. There is one (1) one smoke detector in all bedrooms, the garage and in the hallway. There is a carbon monoxide detector in the hallway and in the garage. There are two (2) wall heaters that are barricaded making them inaccessible to the children. There is also a horizontal wall heater just below the ceiling in the converted garage. The home is equipped with plenty of windows for proper ventilation. Licensee uses portable fans in the garage during the hotter months.

The backyard is fully fenced, clean, well maintained with ample age appropriate materials for the children. There is an in ground swimming pool that has been emptied and meets all of the Title 22 regulations. The front yard is fully gated and has plenty of materials for the children as well.

Licensee is operating within their licensed capacity and is in ratio. Licensee’s Health and Safety training has been completed and Pediatric CPR and First Aid training is complete and expires on 9/10/2024. Licensee’s Mandated Reporter training has recently expired and will be renewed. LPA obtained the fire/disaster drill log with the last drilled logged 3/20/2023. All adults living and working in the home have obtained a criminal record clearance. All required forms are posted in the living room. LPA obtained the children’s files and facility roster.

Licensee was reminded that California Law requires Licensee 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. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.
Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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: VELEZ, MARIA	FACILITY NUMBER: 013423297
	VISIT DATE: 04/06/2023

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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 (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.

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 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. LPA also informed Licensee 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.

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.

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.
Exit interview conducted and report was reviewed with Licensee Maria Velez.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

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