013423545-5-23-2023-02-CC-CFES-CS4MYY-20230523100220

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423545
Report Date: 05/18/2023
Date Signed: 05/23/2023 12:14:08 PM

Document Has Been Signed on 05/23/2023 12:14 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	DELGADO, DEBORAH & GUZMAN BRAULIA		FACILITY NUMBER:	013423545
ADMINISTRATOR:	DELGADO, DEBORAH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 980-2268
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94501
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 9	DATE:	05/18/2023
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Deborah Delgado and Braulia Guzman		TIME COMPLETED:	04:00 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	This is an electronic version of the a written report that was provided on 5/18/23 On 5/18/23, at 1:00pm, Licensing Program Analyst (LPA) Catherine Fernandes met with Licensees Deborah Delgado and Braulia Guzman for a Unannounced Required Annual Inspection. Present during the inspection were four infants and five preschoolers in care. Residing in the home is Licensees, Delgado's underage child. Licensee’s home was toured for a health and safety inspection. The facility operates 8:00am – 5:00pm, Monday - Friday. The home is apart of the South Shore apartments and consist of two bedrooms and two bathrooms. The apartment building requires a key fob to enter through the front door of the home, however the licensee stated that the patio gate located in the courtyard can be used as an entrance. The inside and outside of the home were observed to be neat, clean with age appropriate materials and toys for the children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. During today’s inspection, LPA observed the following precautions, there is a fireplace in the family room that is closed, and off-limit areas have gates to prevent access. Licensee has stated that there are no firearms and there is a dog in the home. ON LIMITS AREA: Living Room/dining room combo which is the main area of the day care, the two bedrooms, the bathroom in the master bedroom and the enclosed patio area OFF LIMITS AREA: the bathroom near the front door, which will be inaccessible by closed and/or locked doors or visual supervision. ISOLATION AREA: the bench near the front door. The home has a fully charged 2A10BC fire extinguisher located on the wall next to the front door and a working smoke detector in the main area of the day care and a carbon monoxide detector next to the front door. There is a working telephone and and push button alarm on the left side of the door. All required forms are posted and visible for public view in the childcare room. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 3/12/2023.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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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Document Has Been Signed on 05/23/2023 12:14 PM - It Cannot Be Edited

Created By: Catherine Fernandes On 05/18/2023 at 02:41 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: DELGADO, DEBORAH & GUZMAN BRAULIA	FACILITY NUMBER: 013423545
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(5)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above the nap room door was closed which poses a potential safety risk to persons in care.
	POC Due Date: 06/15/2023
	Plan of Correction
1 2 3 4	Licensee's will review infant safe requirements and then send a statement of completion to CCL by proof of correction date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Mayla Mendoza

LICENSING EVALUATOR NAME:

Catherine Fernandes

LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: DELGADO, DEBORAH & GUZMAN BRAULIA	FACILITY NUMBER: 013423545
	VISIT DATE: 05/18/2023

NARRATIVE

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Licensee's CPR and First Aid certificate is current and expires on 02/2025. The Licensees were reminded of the responsibility as a mandated reporter and has provided proof of the required training for which was conducted on 3/6/23. LPA did not observe any bodies of water in or around the home.LPA reviewed five the children’s files, two staff files and obtained the facility roster.
The following was observed during today’s inspection: Upon arrival the children were napping in the bedroom, there were two infants sleeping with the bedroom door closed.

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. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. 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. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

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.

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.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: DELGADO, DEBORAH & GUZMAN BRAULIA	FACILITY NUMBER: 013423545
	VISIT DATE: 05/18/2023

NARRATIVE

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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 web page 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.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

See 809D for deficiency cited

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted reviewed with Deborah Delgado

Report, Appeal Rights and Notice of site visit provided.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC809 (FAS) - (06/04)

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