015700233-9-19-2023-52-CC-SCOZ-CVTTTJ-20230919150050

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700233
Report Date: 09/19/2023
Date Signed: 09/19/2023 03:01:35 PM

Document Has Been Signed on 09/19/2023 03:01 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	MOULAS, MARIETTA		FACILITY NUMBER:	015700233
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 4	DATE:	09/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Marietta and Dean Moulas		TIME COMPLETED:	04:15 PM

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Licensing Program Analyst Sidney Cortez, met with licensee Marietta Moulas and her fingerprint cleared assistant/husband Dean Moulas for an Unannounced Annual Random Inspection. Present for this visit was the licensee Marietta Moulas, her husband Dean Moulas, and 3 infants, 1 preschool
The home was toured to conduct a Health and Safety Inspection. The facility currently operates from Monday through Friday from 7:00am until 6:00pm. The home is 1 story. The home consists of 3 bedrooms, 2 bathroom, living room, dining room, kitchen, backyard and garage

The OFF LIMIT AREAS is the 2 bedrooms, and the other bathroom (master bedroom). The
ON LIMIT AREAS are the 1 bedroom (napping area), living room, dining room, hallway bathroom (hallway), play area in the garage and backyard. The ISOLATION AREA is the living room area.

There is no pool or any type of bodies of water in the home. Per applicant, there is no fire-arm in the house. The home is neat and clean with heating and ventilation for safety and comfort.

The home has one fully charged fire extinguisher (model 2A10BC), and working smoke/carbon monoxide detectors, first aid kit, emergency supplies, and working telephone. Licensee’s CPR and First Aid certificates are current and both certificates will expire on Feb 2025. Licensee has a current mandated reporter training which will expire in January 2025

The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on April 2023. (2) Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MOULAS, MARIETTA	FACILITY NUMBER: 015700233
	VISIT DATE: 09/19/2023

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The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

California Law requires Family Child Care Home licensees 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 electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.
The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.
Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC809 (FAS) - (06/04)

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