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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423849
Report Date: 10/10/2023
Date Signed: 10/10/2023 04:51:44 PM

Document Has Been Signed on 10/10/2023 04:51 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:ALLEN, MIAFACILITY NUMBER:
013423849
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
10/10/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
04:01 PM
MET WITH:Mia AllenTIME COMPLETED:
05:01 PM
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On 10/10/2023 at 4:01pm Regional Manager (RM), Diane Perez, Licensing Program Analyst (LPA) Randall Dunevant and Licensing Program Analyst, Indira Loza met with Mia Allen for the purpose of serving a Temporary Suspension Order for the family childcare home. Also present in the home are Assistants Qiuana Bronson and Karen Liso 4 infants were also present, Nicole Bronson-Bell later arrived with Licensee Mia Allen, and Nicole's infant child, bringing the census to 5 infants.

On October 5, 2023, Licensing Program Manager (LPM) Mayla Mendoza and Licensing Program Analyst (LPA) Indira Loza arrived at the home to conduct a complaint investigation. Upon entry into the home, there were a total of 14 infants and five preschool children in care. Children were found in the “Off Limits” areas of the home, which had been documented as the bedrooms, and the lower unit of the home (a finished basement).

On October 5, 2023, Licensee’s mother, Nicole Bronson-Bell was present at the facility, caring for children along with another assistant, neither has a criminal background clearance. Nicole Bronson-Bell, also has a Denied Exemption, meaning that due to her criminal history, Nicole has been denied a clearance to be in the presence of children in a care facility. October 5, 2023 was the second time Mia Allen was cited for Nicole’s presence at the FCCH.

On October 5, 2023, Mia Allen was cited for failure to maintain Sleep Logs for infants in care, a violation of Safe Sleep Regulations. Mia was cited for this violation on a previous date.

On October 5, 2023, Mia Allen was cited for assistants in the home, caring for children did not have First Aid and CPR Training. With Mia’s absence from the facility this day, there was no one in the home that had this training.

On October 5, 2023, assistants in the FCCH did not have employee files.

On October 5, 2023, Children’s files were incomplete, eight children present did not have any of the required ********************************** See LIC809-C for report continuance **************************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2023
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ALLEN, MIA
FACILITY NUMBER: 013423849
VISIT DATE: 10/10/2023
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documents to be kept at the facility that would identify the children, guardians, phone numbers, addresses, health information, emergency contact information and authorized persons to pick up the child when the parent is not available.

Based on the above, the Department has taken action to issue a Temporary Suspension order effective at the close of business today (October 10, 2023). Licensee Mia Allen has the right to file a Notice of Defense with the Departments Legal Division within 15 days of this notice.

Mia Allen was provided the Accusation, and instructions on how and when to file a Notice of Defense. Packets containing the allegations as well as information for the local Resource and Referral Agencies that can help aide in finding alternate care for their children.

A notice of Temporary Suspension will be attached to the front door of the home upon Regional Manager, and LPAs departure from the facility. Mia Allen has been informed that after today, all communication regarding her Family Child Care Home license must be handled by the attorney for the Department only.

All information regarding the name of the attorney, and how to file a Notice of Defense is provided in the Accusation served to Mia Allen.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC809 (FAS) - (06/04)
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