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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409158
Report Date: 03/01/2024
Date Signed: 03/01/2024 05:38:30 PM

Document Has Been Signed on 03/01/2024 05:38 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:SENO, MONALYN & CAPILI, MARIFEFACILITY NUMBER:
073409158
ADMINISTRATOR:SENO, MONALYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 502-1870
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
03/01/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:MONALYN SENOTIME COMPLETED:
05:45 PM
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On 3/1/2024 at 9:40am Licensing Program Analyst (LPA) Tasha Alexander met with Licensee Monalyn Seno (Mona) for a Required - 3-Year Inspection. Present during the inspection was the Licensee, her assistant Michelle, four (4) preschool age children and three (3) infants 12 months and over. Licensee lives in the home with her husband, Rosalio Seno, sister Marife Capili and her husband Reggie CApili, Rochelle Valingasa, 2 minor children, girl and boy 12 yrs and 6 yrs old. Licensee’s home was toured for a health and safety inspection. The facility operates from 8:00am – 5:00pm, Monday - Friday.

ON LIMITS AREA: day care room (living room), bonus room (converted garage adjacent to the living room), hallway bathroom and the left side of the backyard (cemented area)
OFF LIMITS AREA: kitchen, dinning area, all 4 bedrooms, master bathroom, and the right side of the backyard which has been fenced off.
ISOLATION AREA: bonus room(converted garage) adjacent to the day care room.

The facility is a single-story home owned by Licensee Marife Capili. The inside of the home was observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. Licensee stated that she provides all food for the children. Licensee stated that she does not transport children. There are no pets and no firearms in the home.

There is one (1) fully charged 2A10BC fire extinguisher in the childcare room. There is one (1) working smoke alarm/carbon monoxide detector combo located inside of the day care room. Licensees use age appropriate tables and chairs for eating. There is one crib used for infant sleeping. All napping equipment/cots are clean, well maintained and in proper working order and are stored in the laundry area. The home is equipped with central heat and air.
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SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SENO, MONALYN & CAPILI, MARIFE
FACILITY NUMBER: 073409158
VISIT DATE: 03/01/2024
NARRATIVE
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The backyard is fully fenced, clean and has ample age appropriate materials for the children in care. The left side of the yard is fenced off and inaccessible to children in care. LPA did not observe any harmful bodies of water in or around the home.

Licensee is operating within their licensed capacity and is in ratio. Licensee’s Health and Safety training with Lead Poisoning component has been completed and Pediatric CPR and First Aid training is complete and expires / /. Licensee’s Mandated Reporter training is complete and expires / /. LPA obtained the fire/disaster drill log, log is complete with the last drill logged / /. All adults living and working in the home have obtained a criminal record clearance. All required forms are posted in the childcare room by the entrance door. LPA obtained the children’s files, helper's file and facility roster. All files were complete.

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

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.

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SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
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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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SENO, MONALYN & CAPILI, MARIFE
FACILITY NUMBER: 073409158
VISIT DATE: 03/01/2024
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 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.

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.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Licensee Monalyn Seno.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
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Document Has Been Signed on 03/01/2024 05:38 PM - It Cannot Be Edited


Created By: Tasha Hackett-Alexander On 03/01/2024 at 04:49 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: SENO, MONALYN & CAPILI, MARIFE
FACILITY NUMBER: 073409158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
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. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child 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 WAS NOT MET AS EVIDENCED BY: A REVIEW OF RECORDS WHICH REVEALED LICENSEE IS UNABLE TO PRODUCE A FIRE DRILL LOG.
POC Due Date: 03/15/2024
Plan of Correction
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LICENSEE WILL CONDUCT A FIRE/DISASTER DRILL WITH CHILDREN IN CARE, DOCUMENT AND SUBMIT A COPY OF THE UPDATED DRILL TO COMMUNITY CARE LICENSING BY 3/15/24

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Loretta Dyson
LICENSING EVALUATOR NAME:Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024


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Document Has Been Signed on 03/01/2024 05:38 PM - It Cannot Be Edited


Created By: Tasha Hackett-Alexander On 03/01/2024 at 04:49 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: SENO, MONALYN & CAPILI, MARIFE
FACILITY NUMBER: 073409158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2024

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 WAS NOT MET AS EVIDENCED BY A REVIEW OF RECORDS WHICH REVEALED THE ASSISTANT HAS NOT COMPLETED THE MANDATED REPORTER TRAINING.
POC Due Date: 03/15/2024
Plan of Correction
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LICENSEE WILL HAVE THE ASSISTANT COMPLETE THE MANDATED REPORTER TRAINING AND SUBMIT A COPY OF THE UP TO DATE CERTIFICATE TO COMMUNITY CARE LICENSING BY 3/15/24
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 WAS NOT MET AS EVIDENCED BY A REVIEW OF RECORDS WHICH REVEALED, LICENSEE IS UNABLE TO LOCATE A COPY OF HER MEASLE AND FLU VACCINE & HER ASSISTANT IS UNABLE TO PRODUCE PROOF OF VACCINES.
POC Due Date: 03/15/2024
Plan of Correction
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LICENSEE WILL OBTAIN PROOF OF HER FLU AND MEASLES VACCINES AND SUBMIT COPIES TO COMUNITY CARE LICENSING. THE ASSISTANT MUST OBTAIN PROOF OF MEASLES, PERTUSSIS, FLU AND TB TEST RESULTS AND SUBMIT COPIES TO COMMUNITY CARE LICENSING BY 3/15/24
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Loretta Dyson
LICENSING EVALUATOR NAME:Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024


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Document Has Been Signed on 03/01/2024 05:38 PM - It Cannot Be Edited


Created By: Tasha Hackett-Alexander On 03/01/2024 at 04:49 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: SENO, MONALYN & CAPILI, MARIFE
FACILITY NUMBER: 073409158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.

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 WAS NOT MET AS EVIDENCED BY A REVIEW OF RECORDS WHICH REVEALED THE LICENSEE'S ASSISTANT DOES NOT HAVE THE SIGNED EMPLOYEE RIGHTS FORM IN FILE.
POC Due Date: 03/15/2024
Plan of Correction
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LICENSEE WILL HAVE HER ASSISTANT SIGN THE EMPLOYEE RIGHTS FORM AND SUBMIT A COPY TO COMMUNITY CARE LICENSING BY 3/15/24
Section Cited
General Provisions and Definitions
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 03/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024


LIC809 (FAS) - (06/04)
Page: 6 of 10
Document Has Been Signed on 03/01/2024 05:38 PM - It Cannot Be Edited


Created By: Tasha Hackett-Alexander On 03/01/2024 at 04:49 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: SENO, MONALYN & CAPILI, MARIFE
FACILITY NUMBER: 073409158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

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 WAS NOT MET AS EVIDENCED BY A REVIEW OF RECORDS WHICH REVEALED 2 CHILDREN DO NOT HAVE IMMUNIZATION RECORD IN FILE
POC Due Date: 03/15/2024
Plan of Correction
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LICENSEE WILL HAVE EACH CHILD'S PARENT OBTAIN THE CHILD'S IMMUNIZATION RECORDS. LICENSEE WILL DOCUMENT ONTO THE IMMUNIZATION BLUE CARDS AND SUBMIT COPIES TO COMMUNITY CARE LICENSING BY 3/15/24
Section Cited
Child's Records
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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2
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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:Loretta Dyson
LICENSING EVALUATOR NAME:Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024


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