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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423297
Report Date: 07/23/2024
Date Signed: 07/23/2024 02:24:33 PM

Document Has Been Signed on 07/23/2024 02:24 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, MARIAFACILITY NUMBER:
013423297
ADMINISTRATOR/
DIRECTOR:		VELEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 776-3713
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 6DATE:
07/23/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:55 AM
MET WITH:Maria VelezTIME VISIT/
INSPECTION COMPLETED:
02:23 PM
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On 7/23/2024 at 11:55am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Maria Velez for an Unannounced Annual/Random Inspection. Present during the inspection was the Licensee, her two (2) minor foster daughters, one (1) infant and five (5) preschool age children. Licensee lives in the home with her two (2) foster daughters. Licensee’s home was toured for a health and safety inspection. The facility operates 7:00am – 6:00pm, Monday – Friday.

ON LIMITS AREA: Living Room, Kitchen, Hallway Bathroom, 2nd Bedroom on the Right, Detached Converted Garage, Enclosed Patio, Front Yard, and Backyard
OFF LIMITS AREA: Primary Bedroom with Bathroom, 1st Bedroom on the Right (daughter’s bedroom), Pool Area, Two Bedroom dwelling next to the Pool Area
ISOLATION AREA: Living Room or Enclosed Patio

Licensee has requested to remove the 1st bedroom on the right side of the hallway to be off-limit and the 2nd bedroom on the right side of the hallway to be on-limit. LPA inspected the 2nd bedroom and no hazards were found to be accessible to the children in care. LPA approved the bedroom as an on-limit area. Licensee will submit a new facility sketch to reflect the changes made.

The facility is a single-story home rented by the Licensee. The inside of the home was observed to be neat, clean with ample age-appropriate materials for the children’s learning and play. All toxins, personal medication, cleaning products, and hazardous materials were observed to be in inaccessible areas. Licensee provides all food for the children which was observed to be properly maintained and stored. All food that may be brought from the children’s home will be properly labeled and stored. All off limit areas in the home are made inaccessible with gates, and locks. Licensee stated she does not transport children, there are no pets in the home and no firearms in the home.
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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2024
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: 07/23/2024
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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. Licensee uses mats and blankets for sleeping. There are three (3) play yards in the home for infants sleeping. All napping equipment was observed to be clean and well maintained. LPA observed infants sleeping in play yard that do not have fitted sheets on them. LPA reminded Licensee that all play yards and cribs must be equipped with a fitted sheet. Licensee uses child sized tables and chairs for mealtimes.

The front yard is fully gated, and the backyard fully fenced. Both are clean and well maintained with ample age-appropriate materials for the children. There is an in-ground swimming pool in the back yard that is completed gated and has been completely drained. The fence to the pool was observed to be at least five (5) feet high and does not obstruct the view of the pool. The gate swings away from the pool, self-closes, and has a self-latching device located no more than six inches from the top of the gate, all of which meets the Title 22 California Code of Regulations. Next to the pool area in the back yard is a two bedroom dwelling. There are no bathrooms, and each room has a smoke detector. The dwelling and the pool area are off-limits and gated making them inaccessible to the children in care.

The facility is operating within its licensed capacity and is in ratio. Licensee’s Health and Safety training has been completed and EMSA approved Pediatric CPR & First Aid is complete and expires 9/10/2024. Licensee’s Mandated Reporter training is complete and expires 4/9/2025. LPA obtained the fire/disaster drill log. Fire/disaster drills have been conducted and recorded within the last six (6) months with the last drill logged 7/12/2024. 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 files. All files were complete.

No deficiencies were cited during LPAs inspection.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
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: 07/23/2024
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Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's authorized representatives, and to Community Care Licensing Division (CCLD) within 24 hours by phone. Within seven (7) days of the incident, Licensees must submit the Unusual Incident/Injury form (LIC 624B) to CCLD. Licensee was reminded that any structural changes or additions to the home must be reported to CCLD. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting mandatedreporterca.com/. LPA informed Licensee 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/.

Licensee 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.

Licensee 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.


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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: 07/23/2024
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During the exit interview, Licensee Maria Velez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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.

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. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC809 (FAS) - (06/04)
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