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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304200211
Report Date: 10/27/2023
Date Signed: 10/27/2023 04:41:22 PM

Document Has Been Signed on 10/27/2023 04:41 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
ORANGE CO CHILD CARE, 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: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
10/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:02 PM
MET WITH:Rosalba MirandaTIME COMPLETED:
05:00 PM
NARRATIVE
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On 10/27/23 at approximately 1PM, Licensing Program Analyst (LPA) A. Silva conducted an unannounced Required – 1 Year inspection assisted by licensee Rosalba Miranda. Upon arrival, the licensee and one assistant had six clients in care including two infants. An on-site Facility Personnel Report Summary review showed that all facility residents, staff, or other individuals who require background checks have received criminal record and child abuse index clearances or exemptions.

Upon arrival the LPA heard a child crying from a bedroom while standing in the front yard. Upon inspection of the bedroom, the LPA learned the child in the bedroom was infant C1 who is under 12 months of age. The LPA inspected the bedroom where C1 was and noticed no play yard/cribs. It was later determined that C1 had been sleeping in the bed for about 15 minutes according to the licensee statements. The licensee did not move the infant to a play yard when the child fell asleep. The licensee did not have visual of C1 from the day care area. Appropriate citations were issued and listed below. As part of the plan of correction, the licensee will watch the video “Supervising Children in Family Child Care” at https://ccld.childcarevideos.org/family-child-care-providers/supervising-children-in-family-child-care/. The licensee will also review the safe sleep regulations provided by the LPA.

The LPA observed two play yards in the day care area. Both play yards had loose articles inside. The licensee removed the loose articles while the LPA was present. The analyst inquired about the safe sleep 15 minute checks. The licensee stated she does not keep a safe sleep check log for infants. The licensee did not have an LIC 9227 for two infants under 12 months. Appropriate citations were issued for these deficiencies and listed below.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2023
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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Document Has Been Signed on 10/27/2023 04:41 PM - It Cannot Be Edited


Created By: Archibaldo Silva On 10/27/2023 at 02:40 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MIRANDA, ROSALBA
FACILITY NUMBER: 304200211

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on obsrevation, the licensee did not comply with the section cited above in 2 out of 2 play yards, which poses an immediate health, safety or personal rights risk to persons in care. Both play yards had loose articles inside during the inspection. One infant was sleeping in one of the play yards with a blanket, a pillow, a bottle, and two children sweaters.
POC Due Date: 10/28/2023
Plan of Correction
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The licensee removed all loose article from both cribs while the LPA was prfesent. The licensee received a copy of safe sleep regulations and a "what a safe sleep environemtn looks like brochure (spanish version). The licensee will review the regulations and send the LPA a written declaration of completion via email to the email provided no later than the 10/30/23. The LPA reviwed the infant safe sleep regulations with the licensee during the visit.
Type A
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & interview with the licensee, the licensee did not comply with the section cited above in 1 of 2 infants, which poses an immediate health, safety or personal rights risk to persons in care. The licensee did not move infant C1 to a play yard after C1 fell asleep. The licensee stated C1 had been sleeping in a bedroom bed for about 15 minutes.
POC Due Date: 10/28/2023
Plan of Correction
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The assistant pick up infant C1 from the bedroom bed. The LPA reviwed infant safe sleep regulations with the licensee. The licensee will review the regulations again and send the LPA a written declaration of understanding by 10/30/23 via email.
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:Patricia Magana
LICENSING EVALUATOR NAME:Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023


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Document Has Been Signed on 10/27/2023 04:41 PM - It Cannot Be Edited


Created By: Archibaldo Silva On 10/27/2023 at 02:40 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MIRANDA, ROSALBA
FACILITY NUMBER: 304200211

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(j)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview with the licensee, the licensee did not comply with the section cited above in 2 of 2 infants, which poses an immediate health, safety or personal rights risk to persons in care. The licensee stated that she does not do the 15-minute safe sleep checks. Infant C1 was in the bedroom on a bed. C2 was in a play yard with loose articles.
POC Due Date: 10/28/2023
Plan of Correction
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The licensee will review the safe sleep regulations and send the LPA a written declaration of understanding to avoid similar deficiencies from happening again. The licensee will email the written declaration no later than 10/30/23.
Type A
Section Cited
CCR
102425(j)(5)(A)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. The provider shall be able to visually observe the infant without moving the door.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview with the licensee, the licensee did not comply with the section cited above in 1 of 2 infants, which poses an immediate health, safety or personal rights risk to persons in care. LPA heard C1 crying in a bedroom. Upon inspection, LPA observed C1 was sleeping in a bedroom where the licensee has no visual from the day care area.
POC Due Date: 10/28/2023
Plan of Correction
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The assistant picked up infant C1 and returmed C1 to the day care area. The licensee will review the safe sleep regulations provided by the LPA and send the LPA a written delcaration of understanding via email no later than 10/30/23. The safe sleep regulations were reviwed during the inspection.
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:Patricia Magana
LICENSING EVALUATOR NAME:Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023


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Document Has Been Signed on 10/27/2023 04:41 PM - It Cannot Be Edited


Created By: Archibaldo Silva On 10/27/2023 at 02:40 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MIRANDA, ROSALBA
FACILITY NUMBER: 304200211

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and interview with the licensee, the licensee did not comply with the section cited above in 2 of 2 LIC9227 for infants under 12 months, which poses/posed a potential health, safety or personal rights risk to persons in care. During files review, the licensee stated she did not have an LIC9227 for any of the two infants present. C1 is under 12 months. C2 recently turned 1 years of age.
POC Due Date: 11/28/2023
Plan of Correction
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The licensee was provided a copy of the LIC9227. The licensee will complete the LIC9227 for all infants under 12 months including C1 and email a copy to the LPA no later than the due date above via email.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
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: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, the licensee did not comply with the section cited above in 2 of 2 infants under 24 months, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2023
Plan of Correction
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The licensee was given a sample safe sleep log. The licensee will carry out and document the 15-miniute safe sleep checks and send a copy of the logs to the LPA on 11/28/23 via email.
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:Patricia Magana
LICENSING EVALUATOR NAME:Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023


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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRANDA, ROSALBA
FACILITY NUMBER: 304200211
VISIT DATE: 10/27/2023
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A copy of “Sueno Seguro – Preguntas Frecuentes” was provided to the licensee. The licensee will review the regulations within the document and send a written declaration of understanding as stated in the plan of correction and send it to the LPA.

INDOOR INSPECTION. The LPA inspected the indoor FCCH area identified in the Facility Sketch LIC999 and areas accessible to clients. Off-limits areas were inaccessible to clients in care by means of child gates and locks. The facility was equipped with working carbon monoxide and smoke detectors, working telephone service, and at least one fire extinguisher that meets statutory and State Fire Marshall standards. The licensee agrees to maintain telephone service in the home when clients are in care. Hours of operation are 5AM to 6PM. The licensee is aware that each FCCH shall conduct fire drills and disaster drills at least once every six months. A record review shows that the last drill was documented on 9/5/23. There is no fireplace or stairs.

The licensee stated that there are no firearms and/or other dangerous weapons in the facility; none were observed during the inspection. Detergents, cleaning compounds, medicines, and other items that could pose a danger if readily available were inaccessible to clients in care. No poisons or other items that could pose a danger to clients were observed during the inspection. Clients nap on mats. According to the licensee, beddings are stored individually and washed every three days. The facility provides age-appropriate toys, play equipment, and materials for the clients served. The licensee provides breakfast, lunch, and snack to the children. At the time of inspection, food prep areas were clean and sanitary, and food was properly stored. Filtered drinking water is available to clients in care. The LPA observed that the facility’s floors, equipment, furniture, and clients’ bathrooms were clean and in good repair.

OUTDOOR INSPECTION: The playground was enclosed by a fence. The outdoor equipment and toys were in good repair and free of sharp edges. At the time of inspection, the surface of the outdoor activity area was well-maintained and free of any observable hazards. There are no bodies of water in the facility.

PERSONNEL RECORDS: The LPA reviewed the licensee and assistant files. All staff had a current mandated reporter expires and Pediatric CPR/First Aid certification both of which expire in 2025. The immunization records show that the assistant has been vaccinated against pertussis and measles.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRANDA, ROSALBA
FACILITY NUMBER: 304200211
VISIT DATE: 10/27/2023
NARRATIVE
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CHILDRENS’ RECORDS: The licensee has a current roster of clients. The LPA reviewed five records, including two infants, of clients who were present during the inspection. The infant files were not in compliance. The LIC9227 was missing for both infants; one infant is under 12 months of age. Citation issued.

The Incidental Medical Services (IMS) policy was discussed. A link to PIN 22-02-CCP was provided here: PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The licensee understands that he or she shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a qualified substitute adult to care for and supervise the children during his/her absence [A qualified substitute adult is an adult that has criminal record and child abuse index clearances, immunizations, and current Pediatric CPR/First Aid and Mandated Reporter training]. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day, in accordance with Section 102417 of the California Code of Regulations. The licensee understands that children are not to be left alone in parked vehicles.

The licensee understands that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption prior to the initial presence in a licensed child care facility. Violation of this requirement will result in a citation of a deficiency and civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.

The licensee understands that 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, in accordance with Section 1597.622 of the Health and Safety Code.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRANDA, ROSALBA
FACILITY NUMBER: 304200211
VISIT DATE: 10/27/2023
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The licensee understands it is his or her responsibility to review the Provider Information Notices (PIN) found on the CCLD website above. If not yet registered, the licensee agrees to register to receive quarterly updates via email at childcareadvocatesprogram@dss.ca.gov or online at https://cdss.ca.gov/inforesources/community-care-licensing/subscribe

The LPA discussed the following resources with the licensee:
US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY)
Commonly Asked Questions about Child Care Centers and the ADA link: http://www.ada.gov/childqanda.htm
CaSocialService YouTube Guardian Webinar “All Providers Webinar 12/20/22” link https://youtu.be/WNc1kYmlW9s
Guardian information link: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
CCLD link: www.cdss.ca.gov/inforesources/community-care-licensing
CPSC (United States Consumer Product Safety Commission) link: https://www.cpsc.gov/

LPA reviewed the following safe sleep best practices with the licensee:
Always place infants 12 months and younger on their backs to sleep
Use only a tight-fitting sheet on the crib or play yard mattress
Do not hang any items from the crib or above the crib
Keep all items including blankets, pillows, and stuffed dolls out of the crib or play yard
Pacifiers may be used only if they do not have items attached to them and there is no recall
Infants should not be swaddled or have any items covering them while sleeping
The temperature of the room should be comfortable enough for a lightly clothed adult
Complete Individual Sleeping Plan LIC9227 for infants 12 months and younger
Conduct and document the 15-minute checks for all infants under 24 months
CDSS Safe Sleep link: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRANDA, ROSALBA
FACILITY NUMBER: 304200211
VISIT DATE: 10/27/2023
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The facility was NOT in compliance. Violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed, and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: Infant Safe Sleep 102425(b), 102425(i), 102425(j), 102425(j)(5)(A), 102425(c), 102425(j)(2)(D)(c).

LPA A. Silva informed licensee Rosalba Miranda that this licensing report dated 10/27/23 documents 4 “Type A” citation(s). Type A citation(s) must be posted for 30 consecutive days during the hours that children are in care as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. LPA A. Silva further informed licensee Rosalba Miranda that:
A copy of this licensing report must be provided to parents or guardians of all clients currently enrolled by the next business day or by the next day the children are in care.
A copy of this report must be provided to the parents or guardians of all newly enrolled clients for 12 months from the date of this report.
A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) form, or another written equivalent statement, must be placed in the child's file for verification of receipt of the report.

The LPA conducted an exit interview and reviewed the report with the licensee. The “Notice of Site Visit” was posted and the licensee is aware that it shall remain posted for 30 days. The Appeal Rights were explained. The licensee received a copy of the Appeal Rights (LIC 9058 01/16), their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First-level appeals should be sent to the Regional Manager to the address listed above.

To improve the quality and value of the inspection process, a survey will be sent to the email address provided. Please complete the survey to share your inspection experience. If you have any questions regarding the process or tools used during the inspection, email them to inspectionprocess@dss.ca.gov. For more information about the inspection, its tools, and methods visit www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
End of Report.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
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