<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070213499
Report Date: 11/12/2024
Date Signed: 11/12/2024 04:53:17 PM

Document Has Been Signed on 11/12/2024 04:53 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ELIZALDE, MIRTHAFACILITY NUMBER:
070213499
ADMINISTRATOR/
DIRECTOR:		ELIZALDE, MIRTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 285-6161
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 5DATE:
11/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Elizalde MirthaTIME VISIT/
INSPECTION COMPLETED:
05:00 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
On 11/12/24 at 2:00 pm Licensing Program Analysts (LPAs) Mario Caro and Kareeca "Reeca" Sykes conducted an Unannounced Annual Inspection at Mirtha Elizalde's Family Day Care Home. LPAs met with Licensee, Mirtha and explained the purpose of today’s inspection. LPAs were granted permission to enter the facility. Days and hours of operation are Monday - Friday from 7 am - 5:30 pm. Present in the home were Licensee, 1 assistant, 1 fingerprint cleared adult, and 5 day care children (4 infants, 1 preschool age).
LPA toured all ON-LIMIT areas of the home.

On Limit Areas: Florida Room, Family Room, Kitchen, Dining area, Bathroom in Hallway
Off Limit Areas: All 3 bedrooms, Office, Garage, Living room, Master bathroom

LPA's observed sufficient materials, toys, and play equipment for the day care children in the home. Children were engaged in various activities under the supervision of the Licensee and Helper All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Furniture and equipment, such as cribs, mats, feeding chairs, and tables were age appropriate and in good condition. There were no baby walkers, exersaucers, jumpers or bouncers observed on the premises during today’s inspection. The home is sanitary, orderly, and safe for the day care children. LPA's did not observe any wall heaters in the home. There is a screened fireplace in family room. No stairs inside the home. The Licensee has a working telephone in the home.

LPAs observed a fully charged 3A-40-BC fire extinguisher and working smoke/carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. LPAs reviewed a current Children Roster, There was no emergency disaster plan posted. Licensee states she has not conducted or documented fire/disaster drill for a year. Parent Rights Poster PUB394, and Facility License were observed posted on a wall.The Licensee states that she does not transport children.
Continued on page 2
Sherelle JohnsonTELEPHONE: (510) 421-3587
Kareeca SykesTELEPHONE: 510-622-2602
DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ELIZALDE, MIRTHA
FACILITY NUMBER: 070213499
VISIT DATE: 11/12/2024
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
26
27
28
29
30
31
32
Page 2
OUTDOOR space was inspected.

In Use Areas: Left side yard gate leads to entrance into day care. It is also kids outdoor play yard.
Off Limit Areas: Pool, Spa area (gated/fenced and off limit to children)

The outdoor space and play equipment were observed to be maintained in safe condition and free of hazards. The yard was fenced.

FILE REVIEW: Children, Licensee files were reviewed. Helper's file is not maintained. Licensee and Helper do not have current Mandated Reporter Training.

Around 3:00 pm a parent came to pick up an infant, bringing census to 3 infants, 1 preschooler,

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during 80% of the operating hours of the day care and ensure that the children are supervised at all times.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

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.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Kareeca SykesTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ELIZALDE, MIRTHA
FACILITY NUMBER: 070213499
VISIT DATE: 11/12/2024
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
26
27
28
29
30
31
32
Page 3
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage 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.
It is noted that Licensee was provided Safe Sleep Regulation Concepts document during previous annual inspection of 12/12/19.

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.

In the areas that were evaluated, regulatory type B violations were cited for the following violations: Licensee and assistant don't have current mandated reporter training, no emergency disaster plan, assistant does not have immunization's in file, and emergency drill log not maintained. Citations are issued on 809-D pages of this report.

LPA Mario Caro informed Licensee, Mirtha that this report dated 11/12/24 with 4 Type B citations which shall be posted for 30 consecutive days as there is a potential risk to the health, safety, or personal rights of children in care.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Exit interview conducted and report was reviewed with the licensee Mirtha Elizalde.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Kareeca SykesTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 11/12/2024 04:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: ELIZALDE, MIRTHA
FACILITY NUMBER: 070213499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation Licensee did not have a written emergency disaster plan to present to LPAs or to be posted, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/26/2024
Plan of Correction
1
2
3
4
Licensee will submit a photo showing a completed emergency disater plan posted on her Parent wall to LPA Mario Caro By POC Date 11/26/24.
Section Cited
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation Licensee did not provide or maintain evidence of conducted emergency safety drills for fire or earthquake which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/26/2024
Plan of Correction
1
2
3
4
Licensee will submit a photo showing an emergency safety drill log with either a fire or earthquake drill conducted to LPA Mario Caro by POC Date 11/26/24.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Sherelle JohnsonTELEPHONE: (510) 421-3587
Kareeca SykesTELEPHONE: 510-622-2602

DATE: 11/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/12/2024

LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 11/12/2024 04:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: ELIZALDE, MIRTHA
FACILITY NUMBER: 070213499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review Licensee's assistant does not have proof of her immunizations for Pertussis (TDAP), Measles, or Flu shot/opt out which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/26/2024
Plan of Correction
1
2
3
4
LIcensee will submit evidence of her assistants immunizations to LPA Mario Caro by POC date 11/26/24.
Section Cited
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section 102425(D)(a)(b)(c) Documentation shall be maintained in the infant’s file and be available to the Department for review. (a):Date (b): infants name (c) time of each 15 minute check which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/26/2024
Plan of Correction
1
2
3
4
Licensee will submit evidence of an infant sleep log being conducted to LPA Caro by POC Date 11/26/24.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Sherelle JohnsonTELEPHONE: (510) 421-3587
Kareeca SykesTELEPHONE: 510-622-2602

DATE: 11/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/12/2024

LIC809 (FAS) - (06/04)
Page: 5 of 5