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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304200211
Report Date: 07/14/2021
Date Signed: 07/14/2021 03:23:13 PM

Document Has Been Signed on 07/14/2021 03:23 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, 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: 7DATE:
07/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Rosalba Miranda, Licensee TIME COMPLETED:
03:25 PM
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An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA) Villa. LPA Villa was greeted by the Licensee Rosalba Miranda. LPA observed 7 children upon arrival, three infants under two years of age and four school age children. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Licensee states there are 8 children enrolled at the facility, the children’s roster was not updated. The licensee and the children were observed not wearing masks during the inspection. Licensee was reminded about all COVID-19 requirements. The Licensee was operating within the licensed capacity as specified on license. The licensee states there is 1 adult living in the facility. Facility Day care hours are 6:00am-5:00pm Monday through Friday.

During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to childcare children. This is a four bedroom house with two restrooms. Per licensee the off-limits areas are the bedrooms in the home and the other restroom located in the master bedroom. The children use the restroom in the hallway, they eat at the dining room table and also access the back-living room area. The main daycare area is located in the back of the home passing the back living room. There is a glass door separating that area from the rest of the home. The off-limit areas are kept closed during daycare hours per the licensee.

The children also use the backyard for outdoor play. The outdoor area was observed to be clean with age appropriate toys.

There are working carbon monoxide, smoke detector, and fire extinguishers in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Licensee stated there are no firearms and/or other dangerous weapons in the facility, and none were observed during today's inspections.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Yesenia Villa
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2021
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRANDA, ROSALBA
FACILITY NUMBER: 304200211
VISIT DATE: 07/14/2021
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The home has age appropriate toys for the ages served. LPA verified there is a working telephone service (cellular service). Licensee stated the backyard is used for outdoor play, the backyard was observed to be fenced, shaded with age appropriate toys.

There are no bodies of water on the premises. LPA Villa provided instructions related to water play, ratios and supervision requirements to the licensee.

The licensee has a current roster of children in care. Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance.) LPA Villa reviewed records for seven children during today's inspection.

The licensee and assistant’s Pediatric CPR/First Aid certification expired 06/2023 & 06/2023. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, 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. Proof of immunization against pertussis, measles for (licensee and assistant) were reviewed and within compliance. Immunizations records were found to be in compliance for both the licensee and the assistant. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years the licensee and assistants were in compliance with the training.

Licensee states she does not administer any medications to children IMS services were discussed. 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
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Yesenia Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRANDA, ROSALBA
FACILITY NUMBER: 304200211
VISIT DATE: 07/14/2021
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The licensee understands she must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website. Licensee does/does not have lead training Certificate. A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee. A copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee. The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
LPA reviewed with licensee the following safe sleep best practices:
· Always place infants on their backs for sleeping
· 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, out of the crib or play yard
· Pacifiers may be used if they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Yesenia Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRANDA, ROSALBA
FACILITY NUMBER: 304200211
VISIT DATE: 07/14/2021
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**Document deficiencies based on POD training: The facility was not in compliance and 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: 102417(g)(8) Operation of a Family Child Care Home.102418(g) Immunizations and Health and Safety 1597.622(a)(1)-Immunization's (a) (1), Mandated Reporter Health and Safety Code, 1596.8662.

An exit interview was conducted with Rosalba Miranda, in Spanish. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and 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. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.
End of Report.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Yesenia Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
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Document Has Been Signed on 07/14/2021 03:23 PM - It Cannot Be Edited


Created By: Yesenia Villa On 07/14/2021 at 12:40 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: 07/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/16/2021
Section Cited
CCR
102418(g)

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102418(g) Immunizations-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 evidence: Licensee did not have proof of immunizations
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The licensee states she will send proof of immunizations for all six children to LPA Villa via email at yesenia.villa@DSS.CA.GOV BY FRIDAY 07/16/21.
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for 6 children enrolled. Child 1-3 and child 5-7 did not have proof of immunization on file. This poses a potential risk to the health of the children in care.
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Type B
07/16/2021
Section Cited
HSC1597.622(a)(1)

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1597.622(a)(1)-Immunizations (a) (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
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The licensee states she will send proof of immunization to the department by Friday 07/16/21 via email at yesenia.villa@dss.ca.gov
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This requirement was not as evidence assistant and licensee failed to have proof of immunizations on file for her self and assistant. No records for MMR, TDAP or Influenza. This poses a potential risk to the health of the children in care.
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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:Judy Hanson
LICENSING EVALUATOR NAME:Yesenia Villa
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2021


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Document Has Been Signed on 07/14/2021 03:23 PM - It Cannot Be Edited


Created By: Yesenia Villa On 07/14/2021 at 01:01 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: 07/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/16/2021
Section Cited
CCR
102417(g)(8)

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102417(g)(8) Operation of a Family Child Care Home. Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement was not met as evidence by: during this inspection there children's
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Licensee states will be emailing proof of updated roster by Friday 07/16/21 at yesenia.villa@dss.ca.gov.
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roster was not updated. The licensee was missing six children and their information on the roster.This poses a potential risk to the safety of the children in care.
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Type B
07/16/2021
Section Cited
HSC1596.8662

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1596.8662 Mandated Reporter-(2) Provider training including statewide guidance on the responsibilities of a mandated reporter who is a licensed day care provider or an applicant for that license, administrator, or employee of a licensed child day care facility in accordance with the Child Abuse This requirement was not met as evidence by..
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The licensee states she will send proof of completion for general training and provider training for herself and assistant by 07/16/21 via email to Yesenia.Villa@dss.ca.gov
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During this inspection the Licensee and the assistant did not have proof of mandated reporter certificate trainings on file. This poses a potential risk to the safety of the children in care.
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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:Judy Hanson
LICENSING EVALUATOR NAME:Yesenia Villa
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2021


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