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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070211407
Report Date: 12/09/2022
Date Signed: 12/09/2022 05:56:53 PM

Document Has Been Signed on 12/09/2022 05:56 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:SZARMACH, FELICIA & MARIA, POWLAK, JADWIGAFACILITY NUMBER:
070211407
ADMINISTRATOR:SZARMACH, FELICIA & MARIA,FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 639-7612
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
12/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:MARIA POWLAKTIME COMPLETED:
06:15 PM
NARRATIVE
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 Licensing Program Analyst Tasha Alexander met with licensee Maria Szarmach for an unannounced 1 YEAR/REQUIRED inspection. Present for the inspection were licensee, adult assistant Enrina Ferrarias and 9 children in care consisting of 3 infants and 6 preschool age children.. LPA toured the facility and backyard for a health and safety inspection. The children's files were reviewed and are complete. The home's fire extinguisher needs to be replaced or recharged There is a working smoke detector, and working carbon monoxide detector. There is a working telephone in the home, no change in phone number. Per licensee there are no fire arms on the premises. There are no pools, hot tubs, or other bodies of water at the home. All poisons, cleaning solutions and medications are inaccessible to children. Licensee's CPR & 1ST card recently expired (11/2022) assistant has current CPR and 1st Aid training which expires 10/2023 respectively. The off limits areas are all 4 bedrooms, master bathroom, and garage. Licensee was also informed of the licensing web address (www.ccld.ca.gov) for downloading child care forms and (www.myccl.com) to register to receive child care updates.
Licensee [or facility representative] 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.
Loretta Dyson
Tasha Hackett-Alexander
DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2022
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: SZARMACH, FELICIA & MARIA, POWLAK, JADWIGA
FACILITY NUMBER: 070211407
VISIT DATE: 12/09/2022
NARRATIVE
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A review of staff records on 12/6/22 indicates that all facility staff or other individual who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Effective September 1, 2016, a person may not work or volunteer at a child care center or family child care home unless he or she has been vaccinated against pertussis, measles and influenza or has an exemption. Today, licensee and assistant do not have immunization records in file.

Today the newly implemented mandatory mandated reporter training course has also been discussed. Today licensee and assistant do not have certificates in file.


CONTINUED ON 809-C


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
SUPERVISOR'S NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
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: SZARMACH, FELICIA & MARIA, POWLAK, JADWIGA
FACILITY NUMBER: 070211407
VISIT DATE: 12/09/2022
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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.

Please see 809-D for citation



An exit interview was conducted. A notice of site visit was posted.
SUPERVISOR'S NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 12/09/2022 05:56 PM - It Cannot Be Edited


Created By: Tasha Hackett-Alexander On 12/09/2022 at 05:33 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: SZARMACH, FELICIA & MARIA, POWLAK, JADWIGA
FACILITY NUMBER: 070211407

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(c)
Administration of Child Day Care Licensing
(c) Current proof of completion for each licensed child day care provider or applicant for that license, administrator, and employee of a licensed child day care facility shall be submitted to the department upon inspection of the child day care or upon request by the department.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. THIS REQUIREMENT IS NOT MET AS EVIDENCED BY: A REVIEW OF RECORDS REVEALED BOTH LICENSEE AND ASSISTANT DO NOT HAVE MANDATED REPORTER TRAINING CERTIFICATES AVAILABLE FOR REVIEW
POC Due Date: 12/23/2022
Plan of Correction
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LICENSEE AND ASSISTANT WILL COMPLETE/ UPDATE OR LOCATE THEIR MANDATED REPORTER TRAINING CERTIFICATES AND SUBMIT COPIES TO COMMUNITY CARE LICENSING BY 12/23/22
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. THIS REQUIREMENT IS NOT MET AS EVIDENCED BY: A REVIEW OF RECORDS REVEALED BOTH LICENSEE AND ASSISTANT'S IMMUNIZATION RECORDS ARE NOT IN FILE
POC Due Date: 12/23/2022
Plan of Correction
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LICENSEE AND ASSISTANT WILL OBTAIN THEIR IMMUNIZATION RECORDS AND SUBMIT A COPY TO COMMUNITY CARE LICENSING BY 12/23/22. RECORDS MUST SHOW VACCINES FOR MEASLES, PERTUSSIS AND FLU
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:Loretta Dyson
LICENSING EVALUATOR NAME:Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022


LIC809 (FAS) - (06/04)
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