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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304200211
Report Date: 08/04/2021
Date Signed: 08/04/2021 11:54:43 AM

Document Has Been Signed on 08/04/2021 11:54 AM - 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MIRANDA, ROSALBAFACILITY NUMBER:
304200211
ADMINISTRATOR:MIRANDA, ROSALBAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 343-2844
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
08/04/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rosalba Miranda, LicenseeTIME COMPLETED:
12:30 PM
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Licensing Program Analysts (LPAs) Yesenia Villa and Patricia Rivas conducted an unannounced proof of correction inspection on this date. During today's inspection LPAs were greeted by the Licensee Rosalba Miranda also present during this inspection was Guadalupe Miranda the licensees sister who was visiting her from Arizona. There were five children present with two staff, the facility was observed to be within ratio. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the inspection on 07/14/2021 the licensee had (4) Type B Deficiencies. During today's inspection LPAs verified the roster had been updated with the children enrolled. The Licensee provided proof of immunization's for herself for MMR, TDAP and Influenza. The Licensees assistant Carmen Avila is not present and might no longer assist her due to not being able to go get her updated immunization's. Licensee states she is in the process of hiring a new employee and will make sure has all of the required qualifications. During this inspection LPAs verified that all children had their immunization's on file. Licensee has provided the department with a copy of a screen shot related to Mandated Reporter completion. She is having problems printing the Provider Certficate from the website. Her daughter has assisted her in emailing technical support for the mandated reporter training certificate.

There were no citations issued on this inspection. The Licensee was provided with two proof of correction letters clearing her deficiencies cited on 07/14/21. LPA Villa also provided guidance on record keeping and assisted the Licensee in organizing her files. A notice of required forms was issued to the licensee as assistance for children and staff files.

Exit interview was conducted with the Licensee Rosalba Miranda. The notice of site visit was provided, she was informed that failure to keep for (30) days will result in a $100.00 Civil Penalty Fee. Appeal rights were discussed.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Yesenia Villa
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2021
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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